Marginal fracture of the ulna. What is an elbow fracture and how to treat it correctly

- This is a violation of the integrity of the ulna as a result of traumatic impact. May be associated with dislocation radius or be isolated. The pathology is manifested by severe pain, swelling, and impaired movement. With fracture-dislocations, shortening and deformation of the forearm occur, as well as a pronounced limitation of movements in the elbow joint. To confirm the diagnosis, X-rays are performed, and less commonly, CT scans are performed. Treatment can be conservative (reposition, immobilization with a plaster cast) or surgical (fixation with a pin, suture or plastic surgery of the annular ligament).

General information

Clinical traumatology is diagnosed relatively rarely; fractures of both bones of the forearm are more common. Isolated injuries, as a rule, are not accompanied by pronounced displacement and proceed rather favorably. When a fracture of the ulna is combined with other injuries to the forearm and elbow joint the course is more severe, significant displacement and damage to the nerves is possible, more often it is required surgical treatment.

Reasons

Injuries usually occur at home and during sports activities. Some patients have a history of criminal incidents involving the use of sticks, batons, iron rods, etc.

• Isolated fractures of the ulna can occur in people of any gender and age; the cause is usually a direct blow to the forearm.
• Monteggia injuries (fractures of the upper third of the ulna combined with dislocation of the radial head) are more often observed in young and middle-aged men actively involved in sports; they are formed when falling on the arm or during a defensive movement when a person tries to parry a blow with a bent arm.
• In children, a Monteggia fracture is often formed as a result of a direct blow to the inner surface of the elbow joint.

Pathogenesis

An isolated fracture, as a rule, is located in the lower third and is transverse, so the fragments are well held and rarely displaced. Displacement along the axis and length is uncharacteristic, since the correct position of the fragments is maintained thanks to the intact radius. In some cases, there is an angular displacement, which necessarily requires elimination, since in the future it can negatively affect the function of the forearm.

A Monteggia injury is a high-energy injury. With such fractures, the fragments of the ulna are displaced, and the forearm is shortened, as a result of which the head of the radius is dislocated in the proximal radioulnar joint. Such injuries require mandatory reposition; otherwise, in the long term, a deformity of the forearm is formed and dysfunction of the elbow joint is noted.

Classification

There are isolated fractures of the ulna without displacement and with displacement of fragments. Monteggia fractures are always accompanied by displacement; depending on the nature of the damage, orthopedic traumatologists distinguish four types of injuries:

• 1 – the head of the ray is dislocated anteriorly, bone fragments form an angle open anteriorly.
• 2 – the head of the radius is dislocated posteriorly, the fragments form an angle open posteriorly.
• 3 – the head is dislocated laterally, the ulna is damaged in the proximal part.
• 4 – the head dislocates anteriorly, causing a fracture of the proximal parts of both bones of the forearm.

Symptoms

Isolated fracture of the ulna

With an isolated injury, the patient complains of sharp local pain. The area of ​​damage is swollen and sometimes deformed. Hemorrhages are possible. Movements are limited due to pain, the function of the forearm is usually moderately impaired, active extension and flexion of the elbow joint, supination and pronation of the hand are carried out to a small extent, and rotational disorders are most pronounced.

Palpation of the damaged area is sharply painful; when palpating the rib of the bone in the case of a displaced fracture, a “ledge” is determined. Pathological mobility is not always detected during a careful examination; intensive manipulations to detect this sign are not recommended in order to avoid secondary displacement. Axial loading is painful.

Monteggia fracture

The elbow joint and forearm are swollen, deformed, and bruising is possible. The swelling is growing rapidly. A comparative examination reveals some shortening of the forearm on the side of the injury. With posterior dislocations, it is sometimes possible to palpate the displacement of the radial head. In the area of ​​the ulna fracture, a “step” or “ledge” is felt, which has arisen due to the displacement of the fragments.

There are no active movements; when passive movements are attempted, spring resistance is detected. The points of greatest pain are determined in the projection of the head of the beam and in the area of ​​​​violation of the integrity of the bone. When pressure is applied along the axis of the limb, pain occurs in the projection of the fracture. Crepitation is possible.

Complications

Complications are not typical for isolated injuries. Rarely, in the presence of unresolved displacement, a mild deformation of the forearm and a slight limitation of the functions of the limb are noted. With Monteggia fractures, concomitant vascular and neurological disorders are often observed, especially damage to the radial nerve, accompanied by a disorder of movement and sensitivity in the innervation zone.

Sometimes, with Monteggia injuries, compartment syndrome develops, caused by an increase in subfascial pressure as a result of severe swelling of the limb. Signs of this syndrome are increasing persistent pain, pain when pulling the fingers and increased tension in the forearm. After fusion of the bone, in the presence of the listed complications, dysfunctions of the forearm are possible, causing disability.

Diagnostics

Diagnosis of ulna fractures is carried out by a traumatologist. In the process of diagnostic search, medical history data, examination results and instrumental studies are used. The examination program includes the following procedures:

• Objective examination. Swelling is detected, hematomas and deformation of the limb are possible. Pathognomonic signs of a fracture are a bone crunch and the presence of a “step” in the area of ​​damage. Dislocation of the radial head is indicated by characteristic deformation and springy resistance during passive movements.
• Radiography. Is the main one instrumental method. To clarify the diagnosis for isolated fractures, x-rays of the forearm are prescribed in two projections. For Monteggia fractures, radiography of the forearm is performed, including the elbow and wrist joints, using two standard and oblique projections.
• Other imaging techniques. They are of auxiliary value for injuries of the ulna. Sometimes bone CT is prescribed to detail damaged structures, and MRI is prescribed to study the condition of soft tissues.

If a Monteggia fracture is suspected, attention is paid to the presence of neurovascular disorders and the pulse in the radial and ulnar arteries is assessed. If signs of damage to a nerve or vessel are detected, consultations with a neurologist or neurosurgeon and vascular surgeon are prescribed.

Treatment of a fractured ulna

Treatment of an isolated fracture

In the absence of displacement, treatment on an outpatient basis is possible. If bone fragments are displaced, hospitalization in the trauma department is indicated.

• Conservative treatment. For non-displaced injuries, a cast is applied for 6-10 weeks. If there is displacement, reposition is performed, a control photograph is taken after 10 days, and the plaster is kept for 10-12 weeks.
• Surgical interventions. Operations are performed when reposition is unsuccessful and it is impossible to keep the fragments in the correct position. Osteosynthesis of the diaphysis of the ulna is performed with a plate or pin. Immobilization also lasts 10-12 weeks.

In the postoperative period, antibiotic therapy is prescribed, UHF, analgesics, antibiotics, exercise therapy and massage are used. The sutures are removed after 8-10 days, then the patient is discharged to outpatient treatment.

Treatment of Monteggia fracture

The patient is hospitalized in a trauma hospital and closed reduction is performed.

• For extensor injuries, transarticular fixation using a thin pin is sometimes performed to prevent re-dislocation.
• For flexion fractures, fixation of the head with a pin is usually not required.

A plaster cast is applied, a control x-ray is taken, the limb is elevated to reduce swelling (the arm is placed on a pillow or suspended from a special stand), and physiotherapeutic procedures are prescribed. The needle is removed after 2-3 weeks. After 4 weeks, the plaster is replaced, changing the position of the limb. Immobilization is stopped after 8-12 weeks.

Surgical treatment is more often required for the extension type of fracture. Osteosynthesis of the ulnar diaphysis with a pin and suture of the annular ligament are performed. If the ligament cannot be sutured, plastic surgery is performed using an autograft cut from the patient's fascia. The beam head is adjusted and fixed with a knitting needle.

For neck fractures, resection of the radial head is performed; in such cases, a suture of the annular ligament is not required. To speed up fusion, in some cases auto- or homografts (small plates) are applied to fragments of the ulna spongy bone). The wound is stitched up. After the operation, physiotherapy, massage, and physical therapy are prescribed. Immobilization is carried out for 3 months.

In children, the surgical tactics are the same as in adults, the only difference is that they try to avoid head resection for any type of injury, since this can negatively affect the growth of the radius and the function of the forearm.

Forecast

For isolated fractures, the prognosis is usually favorable. Monteggia's injury belongs to the category of complex fractures that are difficult to treat and are often complicated by impaired limb function. IN early period In adults, nonunion or delayed fusion of the ulna is often observed due to a lack of soft tissue on the ulnar side of the forearm.

The outcome may be angular curvature or displacement of the head of the radial bone. Sometimes synostoses (fusions) form between the radius and ulna bones, resulting in limited rotational movements. Subluxations and dislocations of the head of the ulna in the area of ​​the distal radioulnar joint are also possible.

Prevention

Prevention involves taking measures to reduce the level of injuries. It is necessary to observe safety precautions when performing various work at home and at work, playing sports, equipping playgrounds using non-hazardous materials. Measures to reduce the number of criminal incidents (fights) play a certain role.

Elbow joint massage – important procedure in rehabilitation treatment after a fracture. It is prescribed after removing immobilization and putting the skin in order.

It should not have bedsores from plaster, irritation, or dermatitis. The principles of massage are warming up and kneading the tissues of the hand, from the fingers to the shoulder joint.

The area of ​​the joint itself cannot be massaged; this can lead to additional injury to its tissues and increased swelling.

The role of physical exercise after an elbow fracture cannot be overestimated. Only with the help of movements, gradually increasing their volume, can the function of the joint, strength and tone of the muscles of the entire limb be restored.

The exercise therapy program for a fracture of the elbow joint is divided into 2 stages:

1. The first, initial stage, or preventive, when the arm is in a cast. Already from the 2nd day, movements of the hand, fingers, and also in the shoulder are shown - arm abduction, adduction, flexion. Start with a small amount of exercise, then gradually increase it;
2. The second, recovery stage is the development of the arm after removing the bandage until full recovery.

In the first weeks, it is recommended to do exercises in a warm bath, preferably with a solution of sea salt or pine extract, this will relieve spasms and facilitate development. The following exercises are recommended for the elbow joint after a fracture:

• Movements in the elbow joint - flexion, extension;
• Clenching the hand into a fist;
• Rotates the hand outward and inward;
• Rolling out round objects with your palm.

Gymnastics for the elbow joint should be performed 4-5 times a day, repeated 6-10 times. Later they begin exercises with a ball, a gymnastic stick, and on a staircase wall. The exercise therapy instructor will tell you how to develop the elbow joint after a fracture, classes should be under his supervision..

Developing the arm cannot be carried out to the point of severe fatigue, pain and muscle spasm; the load should be gradual.

There are many risk factors for which an elbow fracture may occur. Among them are the most common ones, due to 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 on 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 be received 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, classified complexity of injury.

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.

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 when 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 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:

​A week later, a repeat X-ray is taken to completely rule out 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 restoration of functions is not helped by therapeutic rehabilitation complex, then in this case 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 into place well, 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.​

A fracture of the elbow joint leads to severe pain. Painful sensations intensify when you press on the area of ​​injury. How to develop an injured limb?

Physical exercises begin 3-4 days after injury.

Important! Limb development is the main method that helps restore the functions of the elbow joint. It is enough to straighten the limb at the elbow joint several times a day.

Therapeutic exercise used in the treatment of all types of fractures. After a blow, the victim’s blood vessels rupture and a large hematoma forms.

Special exercises help restore joint mobility. Rehabilitation can reduce the duration of recovery from the consequences of a fracture.

By undergoing physiotherapeutic procedures, it is possible to speed up the recovery of the limb. If there are no serious injuries, treatment can be done at home.

The fracture is accompanied by numbness of the limb due to pinching nerve fibers.

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 medical institution X-rays are taken 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. Carried out by wearing 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 six weeks. Rehabilitation in this case lasts from two weeks to one and a half months.

Surgical treatment

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 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 raised above the head and placed behind the head.

Symptoms

When an arm is broken at the elbow, a triad of symptoms is characteristic:

• Sharp pain;
• Swelling and deformation of the elbow;
• Limitation of movements.

The pain during a fracture is very strong, it can radiate to the forearm, hand, or shoulder, and when you try to move, it intensifies sharply. Deformation or change in the contours of the joint is typical for displaced fractures; the arm may be in an unnatural, forced position. Later, swelling of the tissue around the joint develops.

A sharp restriction of movements or their impossibility indicate displaced and intra-articular fractures. If there is no pronounced displacement, then active (volitional) movements are limited, and passive ones can be preserved, for example, in case of a fracture of the olecranon process or the condyles of the shoulder.

Do not try to determine active and passive movements in the joint, this may lead to increased displacement and swelling.

To correctly diagnose an injury, it is enough to pay attention to the characteristic symptoms of a broken ulna:

• swelling in the elbow;
• partial immobilization of the elbow joint;
• the appearance of a hematoma at the site of injury;
• severe pain throughout the entire limb.

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 injury to the hand, 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. Trauma to the coronoid process of the elbow joint is described as severe aching pain, increasing 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.

The main symptoms by which doctors diagnose a fracture of the ulna are:

• severe pain throughout the injured arm, sharply intensifying upon palpation of the anterior surface of the ulna;
• the presence of a hematoma, as well as swelling at the site of injury, in case of severe damage - a visible change in the shape of the arm, protrusion of bone fragments from under the skin or from the wound in the case of an open fracture;
• impaired mobility of the elbow, any movements in the elbow joint cause severe pain and springy sensations or are completely impossible without outside help;
• unnatural mobility of the elbow joint, the possibility of directions of movement that are not typical for the elbow when in good condition;
• decreased sensitivity of the injured hand, numbness, impaired ability to move fingers.

As a rule, the initial conclusion about a fracture is made by a traumatologist as a result of examining the injured limb. However, in order to confirm the diagnosis, they must turn to one of the x-ray methods of examination.

In most cases, to obtain the necessary objective picture of the injury, simple radiography in two projections is sufficient. However, in the case of a serious injury with displacement, the presence of a large number of bone fragments, or a suspected fracture of the olecranon process with damage to the elbow joint, the prescription of more expensive methods, such as magnetic resonance imaging and computed tomography, which can provide a three-dimensional picture of the injury, is justified.

A fracture of the middle part of the tubular body of the ulna without displacement is treated conservatively, by immobilization by applying a plaster cast. If there is a slight displacement, reposition of the bone fragments is carried out before casting, if with its help it was possible to achieve a normal position of the bone, surgery is not produced.

In cases where there is a strong displacement - an intercondylar fracture of the upper head of the ulna, a fracture of the olecranon, especially with a fracture of the lower bone fragment, damage to the elbow joint with displacement, dislocation - surgical intervention is indicated. Also, surgery is always performed for an open fracture of the elbow joint.

A week after the initial medical intervention, an X-ray examination must be performed again to completely exclude the possibility of improper bone fusion.

Surgery

For serious injuries of the ulna and elbow joint, several types of surgical intervention are used; the choice of a specific type is determined by the specifics of the injury. Fragments of damaged bone can be fastened using plates or pins, a screw inserted into the bone canal, or wire or Mylar thread inserted into canals specially made in the fragments.

Immediately after the operation, a deep plaster splint is applied to the arm, after which the arm is fixed in a scarf sling at an angle of 60-90 degrees. The cast is worn until the bone fusion is complete (sometimes up to 3-4 months, for diabetes and other diseases in which bone fusion is impaired - more than six months).

Rehabilitation measures used when recovering from an injury to the ulna can be divided into three large groups:

• Therapeutic exercise. The timing of restoration of full mobility of the injured limb depends on exercise therapy. Ignoring this component of rehabilitation can lead to the loss of part of the functionality of the hand. Exercises should be started as early as possible - 3-4 days after the fracture. For example, in case of a fracture of the olecranon process, it is necessary to begin developing the fingers in the first days after the injury, since the muscles that control the fingers are associated with the olecranon process.
• Physiotherapy. Physiotherapeutic procedures (UHF, microwave, electrophoresis) for fractures can have a healing and anti-inflammatory effect, stimulate muscles and nerve endings. Physiotherapy is recommended as early as possible for a fracture of the styloid process of the ulna - here they are needed for the speedy restoration of the nerves that are often affected by this injury.
• Massage. It is necessary to improve blood circulation in affected tissues, as well as to maintain muscle tone while they cannot be sufficiently loaded.

A set of exercises for the rehabilitation of a fracture of the ulna

When the ulna is fractured, the load on the limb increases gradually. While the hand is in a cast, it is recommended to develop finger mobility and train the hand by clenching a fist (a little later - with an expander). Subsequently, exercises such as:

• games with a ball, ball, car on the table to develop hand motor skills;
• exercises with light (no more than 2 kg) dumbbells and weights;
• closing hands in a lock, raising hands closed in a lock.

The most common complications observed after a fracture of the ulna are:

• Non-union or delayed bone fusion;
• malunion, secondary displacement of the bone under the cast;
• impaired joint mobility (elbow, wrist);
• rejection of implants (plates, pins, etc.);
• with an open fracture - infectious infection of the wound (the most dangerous infections are tetanus, sepsis);
• impaired sensitivity of nerve endings;
• thrombus and fat emboli (vascular blockages).

As mentioned above, these fractures are more common in children than in adults. The specificity of an injury such as a fracture of the ulna in a child is that the child’s bones have not yet fully formed. Therefore, on the one hand, they grow together faster, on the other, they break more easily. The risk of malunion is significantly higher.

In addition, children, as a rule, are very mobile, so it is extremely important for adults to ensure that the child in the first days after receiving an injury does not show excessive activity with his hand, which can lead to displacement.

A fracture of the process is quite common when the arm is injured. If it is fractured, severe pain may occur along the back surface of the affected joint, radiating to the shoulder and forearm area.

Swelling and bruising are localized on the front of the affected joint, and are associated with an outpouring of blood into the affected area. In addition, in the case of a fracture of the olecranon, active extension is impaired, since the triceps brachii muscle, which is responsible for this movement, is attached to the area.

The rotational movement of the forearm suffers a little. The crunching of fragments is noticeable, and deformation changes are visualized in the event of displacement of fragments.

In case of a fracture of the head and neck of the radius, pain is felt on the front side, radiating to the forearm. The severity of bruising and swelling is slight.

It is rare to hear fragments crunching, and no visible deformation changes are visible, even if they are displaced. Distinctive feature of this fracture are sharp restrictions on the rotational movement of the forearm.

In case of a fracture of the coronoid process of the ulna, pain appears in front of the elbow joint. Painful symptoms increase with palpation. Flexion/extension of the elbow joint is limited. A slight swelling can be noted, and there are no deformational changes.

Typically, a displaced fracture of the elbow joint is difficult to confuse with another ailment. But if it occurs without displacement and there is simply a crack present, a diagnosis of “severe contusion” is often made instead. Indeed, in the latter case the symptoms are very similar:

• Pain on palpation.
• Severe swelling.
• Presence of visual changes, including bruising.
• Inability to perform flexion/extension.

Often the patient exaggerates the degree pain syndrome. This may confuse the doctor.

What is an olecranon fracture of the ulna?

​intra-articular (with or without displacement of the bone processes).​

What happens during an olecranon fracture?

​delayed fusion or non-fusion of the ulna;​

​bruising, swelling of the elbow joint and forearm;​

Symptoms of an olecranon fracture

In case of a displaced fracture, closed reduction of the ulnar bone fragments is performed and then a plaster cast is applied. The duration of treatment for a displaced fracture can be up to 12 months.​

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

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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. At simple fracture For the proximal end of the ulna, treatment involves 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.

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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 for 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

Treatment

After examining the victim, an x-ray of the elbow in 2 projections is usually immediately prescribed.

If a regular photo does not give complete information or if the fracture is complex, computed tomography (CT) or magnetic resonance imaging (MRI) is additionally prescribed.

It allows you to determine not only bone damage, but also the condition of blood vessels, nerves, ligaments, and muscles.

Treatment of elbow fractures can be divided into 3 stages:

• Reposition of fragments;
• Limb immobilization;
• Rehabilitation.

Reposition

Juxtaposition is necessary when there is no displacement or it is acceptable for bone fusion. In other cases, as a rule, open reduction of the fracture is performed with the application of osteosynthesis (connection of fragments), suturing of ligaments and other injured tissues.

For osteosynthesis, various metal structures are used - knitting needles, staples, plates, screws, and in each case the most optimal option is selected.

Immobilization

While the fracture heals, a plaster cast is applied from the armpit to the wrist. It can be in the form of a back splint, or a solid, circular one, depending on the nature of the fracture.

The fixation period can last from 3 weeks to 2 months.

The arm is fixed in the most comfortable position, bending the elbow at an angle of 90-110°. After removing the bandage, restorative treatment is prescribed.

Often, elbow fractures are combined with dislocation or displacement. This requires timely assistance from a specialist to increase the chance of resuming the normal functioning of the injured limb.

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, allowing you to also 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.

It is not recommended to put any weight on the affected arm for 3 weeks, after which the cast is removed. In the future, it is necessary to develop the elbow joint, and for this, a rigid fixator is used, replacing plaster and not interfering with movements.

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.

A fracture of the elbow joint in a child and an adult is diagnosed using an x-ray examination. In some cases, it is necessary to confirm the diagnosis using computed tomography.

A non-displaced fracture of the elbow joint can be treated by applying a plaster cast. It is applied from the upper third of the shoulder when capturing the elbow and wrist joints. The cast is worn for 6 weeks.

If a fracture in a child or adult is accompanied by displacement, then an operation is performed in which the fragment is fixed using metal wires and knitting needles. A displaced fracture is rarely reduced, since it is often not effective along with tension of fragments of the triceps brachialis muscle.

Thus, the treatment period is 2-3 months. The needles can only be removed several months after the injury.

In case of a fracture of the neck and head of the radius without displacement, the area is immobilized with plaster for several weeks. If there is a displacement, reduction is carried out, and if this does not work, then surgical intervention is required when the broken bone fragment is removed. The general treatment period is several months.

If the coronoid process is fractured, the joint is immobilized for a period of 3 to 4 weeks. Total time treatment together with rehabilitation period is 2 months.

In order to correctly diagnose a fracture of the arm in the elbow joint, a visual examination alone is not enough. People have different pain threshold, therefore, you cannot focus only on unpleasant sensations, swelling and bruises.

A fracture of the elbow joint in a child or adult can be accurately diagnosed only after an X-ray or MRI has been performed. Moreover, the latter examination method is the most preferable.

It is also necessary to identify the presence of concomitant ailments:

• Arthritis, including acute form.
• Arthrosis, including a form in which there are serious changes in bone and joint tissues.
• Inflammation of the synovial bursa. A serious complication here is the purulent form, which can lead to the formation of a fistula. In this case, treatment will take months.

Anyway accurate diagnosis requires the simultaneous use of several methods - blood, tissue, radiography or MRI.

Important: to diagnose a fracture of the coronoid process, an atypical x-ray is taken in an oblique projection. In the normal position of the hand, it is projected onto the radius, more precisely, its head.

The first step in diagnosing a fracture is collecting information from the patient. It is necessary that he describe in detail the situation in which the injury occurred. This needs to be done not only to determine the disease. Often, an injury has legal consequences if the fracture was caused by an accident or physical impact.

Particular attention is paid industrial injuries. If they are not properly documented, the victim will not receive financial compensation.

Be sure to clarify what time the accident occurred and what primary medical care was provided. General information regarding the presence of bad habits, chronic diseases, and previous injuries is also added to the anamnesis.

Note the characteristics of the patient's behavior, appearance, mental adequacy. If alcohol or drug intoxication is suspected, appropriate clinical examinations are carried out and a report is drawn up.

The second stage is a visual inspection. The doctor measures the length of the limbs and compares them with each other and with average data.

The following reliable signs of a fracture are identified:

• Crunching of bone fragments or their obvious presence in open wound.
• Feeling the fragments under the skin.
• Deformation of the axis or change in the length of the tubular bone and the presence of pathological mobility at the site of the suspected injury.

If any of these signs are present, a diagnosis of fracture is made.

Important: it is impossible to specifically cause the effect of crepitation (crunching of fragments).

One of the additional methods of examining the joint is puncture. It is used to remove fluid from the injured area. It is examined for the presence of pus, blood, and synovial fluid.

Based on this, diagnoses such as hydrarthrosis, hemarthrosis, synovitis, and purulent arthritis can be added to the fracture.

When a fracture of the radial head occurs, treatment consists of the following steps:

1. Pain relief using novocaine blockade.
2. Stop bleeding from an open fracture.
3. Elimination of displacement of bone fragments.
4. Limb immobilization.

If the fracture is not treated correctly, there is high risk development of infectious tissue infection. Particular attention is paid to the minimum amount of time required to fix the limb. It is necessary to understand that how long to walk in a cast is determined individually in each case.

The time for bone tissue regeneration directly depends on the age of the victim. Fractures in children heal much faster than in older people. If a complex displaced fracture is present, wire placement may be required.

Applying a plaster cast or splint is an important step in the treatment of a fracture.

Not only wearing comfort depends on the correct modeling of the shape. If the form is created incorrectly, there can be very serious consequences, including tissue necrosis.

Nowadays there are factory-made splints and orthoses of varying degrees of fixation on sale. If you have the financial opportunity, it is better to use them rather than a hand-modeled plaster cast.

Complications caused by incorrect application of a plaster cast

The most common complication is tissue compression. The most severe consequences for the patient, expressed by total necrosis, also occur. Typically, the cause is increased swelling.

A sign of this complication is an increase in pain and impaired blood supply to the limb. To eliminate them, it is necessary to cut the plaster cast along its entire length and separate its edges.

The doctor performs an external examination of the injured limb. Inflammation in the wound area is a sign of an open fracture. The nature of the damage can be assessed using the following procedures:

1. A CT scan may be required to make a more accurate diagnosis. In this way, specialists obtain valuable information about the patient’s blood vessels.
2. Expensive examination is used for complex displaced fractures that require long-term treatment.

It is possible to help patients at home only with minor injuries to the elbow.

If displacement of bone fragments is detected, patients are referred for surgery. Osteosynthesis is used to eliminate the consequences of injury.

In this case, the surgeon uses a wire. The operation consists of a specialist carefully tightening the fragments in a certain position.

After the operation, the edges of the wound are sutured and covered with a bandage soaked in an antiseptic solution. The plaster cast is removed after a follow-up diagnosis.

The duration of rehabilitation depends on the severity of the injury. Usually the bones heal within 3-4 months after surgery.

Important! What to do if a spoke breaks off? In this case, a repeat operation is required. It must be removed from the patient's bone tissue.

Specialists prescribe painkillers (Ketoral, Baralgin) to victims. A plaster cast is applied to the injured arm, which is designed to fix the limb in a stationary position.

How to restore the functionality of your arm to avoid pain from the shoulder to the elbow, as well as discomfort from the elbow to the hand? For this, experts have developed a special set of exercises.

To destroy pathogenic microorganisms, agents with an antibacterial effect are used. In the case of an open fracture, particles of earth often get into the wound. They may contain dangerous pathogenic bacteria. When treating patients with skin lesions in the elbow area, antitetanus serum is prescribed.

Severe blood loss can lead to serious consequences. Victims are prescribed hemostatic agents. To reduce the risk of complications, Vikasol and Etamzilat are used. These agents prevent the formation of hematoma after vascular damage. The fusion of bone tissue can be accelerated by taking medications containing calcium.

First aid

Immediately after receiving an elbow injury, the victim needs first aid. Its objectives are: to reduce pain and prevent further displacement of bone fragments and associated complications by applying immobilization.

To reduce pain, you can give painkillers and sedatives, as well as drugs from the group of NSAIDs (non-steroidal anti-inflammatory drugs): ibuprofen, Nolotil, diclofenac and analogues.

To reduce swelling, apply cold to the elbow area.

Immobilization is applied in the position that was formed after the injury. You should not try to straighten your arm or change its position. It is enough to secure it with a bandage, scarf, or piece of fabric, preferably to the body (if possible), and then take the victim to the hospital.

Rendering first aid 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 first aid fit into several following measures, significantly simplifying 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.

Important! It is worth making sure that the injured arm is bent at a right angle.

• 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 ice can play the role of ice. cold water or frozen semi-finished product.

Important! Dry ice or just a cold object must be wrapped in soft cloth before applying to the injury.

If you have a non-displaced or slightly displaced ulna fracture, it is important to immediately immobilize the injured arm. This is done using a splint made from improvised means (any flat boards, firmly fixed with a bandage, rope, scarf).

If you have any painkiller at hand, you must give it to the victim, provided that he is conscious.

With an open fracture, it is extremely important to avoid infection of the wound and stop blood loss. For this purpose, the injury site is treated along the edges with alcohol or an antiseptic, a sterile bandage is applied, and a tight tourniquet is applied above the wound to stop bleeding (it is important to record the time of application of the tourniquet.

If it is not loosened after an hour and a half, the tissues above will begin to die due to lack of nutrition, and the arm will be lost).

In case of a fracture of the elbow joint in a child or an adult, first aid will consist of immobilizing the damaged area with a splint from improvised means. It is worth remembering that if you cannot apply the splint yourself, then you do not need to do this, it is better to just tie your hand on a scarf.

The pain can be eliminated with any painkillers. Movement of the elbow joint is prohibited, as is self-reduction of the fracture.

First you need to limit the mobility of the injured limb. To fix the elbow, you can use a splint. It can be made from materials located near the victim. If the injury occurred at the dacha, then you can use planks or rods.

Often the head of the radius is deformed from a strong blow. The most difficult thing to treat is an old elbow fracture. Before applying the splint, the injured arm must be bent at an angle of 90 degrees.

What to do if the patient is in severe pain? In this case, you will have to give up trying to bend the limb. Lock your hand in its original position. Be sure to wrap the tire with a bandage.

Unprotected surfaces of objects may cause additional damage.

If there is an open fracture, pre-treat the wound antiseptic solution. The child begins to complain of partial loss of mobility. For minor injuries, doctors use medication.

Rehabilitation

Fracture healing alone is not enough to normal operation whole hand. The injury itself plus prolonged immobilization lead to tissue swelling, poor circulation and, as a consequence, muscle atrophy and degenerative disorders in the joint tissues.

To eliminate these phenomena, a course of restorative treatment is necessary. It begins already 2-3 days after the injury. Movements in joints free from plaster casts (shoulder, fingers) and physiotherapeutic procedures are prescribed. All this is necessary to improve blood circulation and develop strong callus.

After removing the plaster cast, active development of the elbow joint begins, and massage is started. Rehabilitation gives good effect when it is carried out comprehensively. Its duration can range from 2 weeks to 2 months.

Nutrition is also important during the recovery period, more details here.

Early complications occur in the first hours and days after injury: damage to nerves and blood vessels, wound infection, and pinching of soft tissues. They are eliminated in the first days surgically.

Late complications develop during the period of immobilization and later. These include: malunion of the fracture, nonunion and formation of a false joint, development of arthrosis, contracture (stiffness) of the joint. Their prevention largely depends on the quality of comparison and rehabilitation treatment, and the participation of the patient himself in it.

The success of treatment for a fracture of the elbow joint depends both on the quality of comparison and fixation of bones, and on the completeness of rehabilitation treatment with the active participation of the patient in it.

IN recovery period After an injury, a number of measures are taken to restore the functioning of the injured limb and normalize blood circulation. There are a number of methods that are carried out under the supervision of a rehabilitation physician.

• To reduce pain, the patient undergoes physiotherapeutic procedures using high-frequency electromagnetic fields and modeling currents. Later, electrophoresis is used.
• Massage will improve blood circulation. A physical therapy complex, selected individually, will quickly restore the sensitivity and function of the limb impaired due to injury.
• The following are also shown medical procedures, such as ozokerite, paraffin therapy, thermal baths. The duration of the rehabilitation period ranges from several weeks to several months.
• During the rehabilitation period, an important factor is balanced diet, enriched with calcium-containing products - milk, cottage cheese, cheese, etc.

The patient’s recovery, the healing of damaged bone tissue, and subsequently the quality of his life largely depend on the qualifications and experience of the doctor involved in the treatment of injury. The upper limb is an important component of the human skeleton. Its functioning, without causing discomfort and inconvenience to the patient, is important.

Ignoring doctor's orders during the treatment process or refusing rehabilitation measures can negatively affect natural functions, lead to the patient's disability or partial loss, and limitations in fulfilling the role assigned to it.

To avoid serious fractures, you need to constantly train the ligaments and joints of your hands. To do this, you need to perform physical exercises with loads. Several times a year, preferably in spring and autumn, you need to consume vitamin complexes, which will compensate for the lack of useful elements in the body.

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.

After removing the plaster cast, it is necessary to restore normal mobility to the elbow joint. They do this with the help of exercise therapy. The exercises are quite simple and consist of flexion/extension of the joint and gradually increasing the load.

The doctor shows how to develop the elbow joint. In the future, the patient can perform these exercises independently. Massage is also indicated; after a fracture, it accelerates the recovery of muscle tissue. Often the patient can do it himself.

In fact, development of the elbow joint after a fracture takes up to two months. Only after this period will the lost functions be fully restored. Usually, in addition to exercise therapy and massage, the patient is also prescribed physiotherapy.

A visit to the swimming pool is recommended. In water, performing exercises is much easier, pain is absent or less pronounced.

Therapeutic exercises must be done three times a day. At first, the exercises will cause discomfort and pain may occur. Can't give right away heavy load, this will lead to a worsening of the condition.

Children are prohibited from performing exercises without adult supervision. During the rehabilitation period, heavy lifting should not be carried. If these requirements are not followed, swelling and bone deformities may occur.

Physiotherapy procedures are prescribed 2 weeks after the injury. Magnetic therapy, electrophoresis, therapeutic applications and massage have a beneficial effect. To restore the limbs to working capacity, it is necessary to regularly perform special exercises. You can really develop your arm only through daily training.

Magnetotherapy

During the procedure, pulsed magnetic fields are applied to the patient's injured area. The victim's blood microcirculation improves.

However, magnetic therapy cannot be used by all victims. Under the influence of a magnetic field, blood thins.

The procedure cannot be used to treat patients suffering from plasma coagulation disorders. Patients with cancer will have to refuse treatment.

Magnetic fields interfere with the functioning of pacemakers.

Therapeutic exercise

The set of exercises begins 3-4 days after receiving a fracture. The injured arm is fixed with a plaster cast. The patient in this condition can move his fingers.

After removing the bandage, you can begin to perform the following exercises:

1. Place the ball on a high table and start rolling it with your sore hand. In this case, the forearm will be developed.
2. Now perform elbow extension. The exercise must be performed simultaneously with healthy hand.

If painful sensations appear, you must stop training. In the future, you can increase the load by performing exercises with dumbbells.

Massage

When treating a damaged limb, a massage therapist uses several techniques:

• kneading;
• tingling;
• stroking.

The duration of the procedure should be increased gradually. Rough movements can lead to displacement of bone fragments. For minor injuries, massage procedures can be performed at home.

Nutrition

After an injury, the patient is recommended to eat foods containing calcium. To speed up bone tissue regeneration, it is necessary to include fish, dairy products and nuts in your diet. The body needs vitamin D, which is involved in the process of bone fusion.

The fracture must be treated immediately after the injury occurs. In this case, the patient can completely restore the function of the elbow joint.

Infection complicates the wound healing process. In this case, antibacterial drugs are used to destroy pathogenic microorganisms.

Displaced fractures require surgical intervention. Recovery after surgery occurs within 4 months.

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

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

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

The ulna and radius form the bony base of the forearm, so when they are damaged, there is a permanent disruption of the functioning of almost the entire arm ( hand, wrist joint, forearm, elbow joint). This greatly affects the daily activities of patients. However, despite the severity of such fractures, they are quite easily diagnosed, and their treatment mainly consists of reduction ( reduction) bone fragments and application of a plaster splint ( bandages) on the injured hand. Such patients usually return to work within a few weeks or months. It all depends on the type and severity of the fracture, as well as the presence of any complications.

Anatomy of the forearm region

The forearm is the middle region of the arm, extending from the elbow joint to the wrist joint. The bony skeleton of the forearm is formed by two bones - the ulna and the radius. These bones are covered on top with muscles, subcutaneous fat and skin. The ulna and radius bones in their upper part take part in the formation of the elbow joint, and in the lower part - the wrist joint. Therefore, these joints can be classified as the forearm area.

The forearm includes the following anatomical structures:

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

Bones of the forearm

There are only two bones in the forearm ( ulnar and radial). These are long tubular bones, each of which has a lower, middle and upper part. The lower and upper portions of the radius and ulna are called the distal and proximal epiphyses, respectively. The middle part of these bones is called the diaphysis ( or body). Between the epiphyses and the diaphysis there are border areas called metaphyses. Thus, each bone of the forearm has two epiphyses ( top and bottom), two metaphyses ( top and bottom) and one diaphysis.

The bones are covered on top with periosteum, and inside they contain yellow bone marrow ( adipose tissue) and red bone marrow ( hematopoietic organ). Yellow bone marrow is localized in the middle part of the bones of the forearm, red - in the epiphyseal ( in the area of ​​epiphyses). In the metaphyseal area there are bone growth layers that allow the radius and ulna to grow in length. Between the red bone marrow and the periosteum in the epiphyses there is spongy bone substance ( textile). In the diaphyses of bones, between the yellow bone marrow and the periosteum there is compact bone substance ( textile). Compact bone tissue is denser and stronger than cancellous bone tissue. Therefore, the bones of the forearm are most resistant to mechanical loads in their middle part ( in the area of ​​the diaphysis).

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

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

Muscles

The muscles of the forearm are divided into three main groups. The first group of muscles helps the hand move closer to the forearm, that is, bend at the wrist joint ( flexor carpi ulnaris, flexor carpi radialis, flexor digitorum superficialis, etc.). Also, some of them are involved in flexing the forearm at the elbow joint ( brachioradialis muscle, superficial flexor digitorum, etc.). These muscles are called flexor muscles.

The second group of muscles allows the forearm and hand to rotate around their longitudinal axis. Inward rotation ( inwards) pronator muscles help ( pronator teres, flexor carpi radialis, pronator quadratus, etc.). Rotation to the outside ( outward) is provided with the help of the supinator muscles ( brachioradialis muscle, supinator, etc.). The third group includes the extensor muscles. These muscles allow the hand to extend at the wrist ( extensor carpi radialis brevis, extensor carpi radialis longus, etc.), and the forearm - in the elbow ( extensor carpi ulnaris, extensor digitorum, etc.) joint.

Skin and subcutaneous fat

The skin, together with subcutaneous fat, covers the entire forearm area. In its structure, the skin of the forearm is no different from the skin of other parts of the body.

Vessels and nerves

The main main vessels of the forearm are the radial and ulnar arteries. These arteries begin at the elbow, branching there from the brachial artery. The radial artery has a longitudinal course and is located deep in the muscles with the lateral ( external side) sides of the forearm. Most of this artery throughout the forearm is located very close to the radius. The largest vessel originating from the radial artery in the forearm is the radial recurrent artery, which participates in the formation of the ulnar arterial network.

The ulnar artery, in turn, is located closer to the ulnar artery. It follows the course of the ulna and is localized closer to the inner surface of the forearm. In the area of ​​the forearm, the ulnar recurrent artery departs from it, which contributes to the formation of the ulnar arterial network, as well as the common interosseous artery. This artery separates from the ulnar artery in the upper third of the forearm. A little lower it bifurcates and divides into the anterior one ( located anterior to the interosseous membrane) and back ( localized posterior to the interosseous membrane) interosseous arteries that follow distally ( down), to the hand, located in the space between the bones of the forearm.

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

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

In the area of ​​the forearm there pass the main nerve trunks - the radial, ulnar, median nerves, as well as additional ones - the lateral and medial cutaneous nerves of the forearm. The radial and ulnar nerves are located closer to the bones of the same name. Median nerve occupies an intermediate position in the forearm. All three nerves follow along the front surface of the forearm from the elbow towards the hand. The lateral cutaneous nerve of the forearm is a continuation of the musculocutaneous nerve ( one of the nerves of the shoulder). The medial cutaneous nerve of the forearm serves as a direct continuation of the medial ( internal side) bundle of the brachial plexus.

Elbow joint

The elbow joint is a formation through which the bones of the forearm and the bone of the humeral region of the arm are united ( humerus). The upper parts of the ulna bone ( olecranon, coronoid process), radius ( head, neck) and lower parts ( block and head of the condyle) epiphysis of the humerus. Due to the presence of the elbow joint, the forearm can perform rotational movements ( internal rotation and external rotation), flexion and extension movements.

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

Wrist joint

The wrist joint is a formation that connects the forearm and hand. The lower ends of the radius and ulna and the bones of the proximal ( upper) wrist row ( semilunar, triquetral, scaphoid). The articular surface of the lower epiphysis of the radius connects directly to the bones of the wrist, in contrast to the epiphysis of the ulna, which connects to them through a cartilaginous disc. Various movements of the hand are possible in this joint - flexion, extension, abduction, adduction, rotation.

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

Strengthening the two bones of the forearm among themselves is ensured not only through the elbow, wrist, proximal and distal radioulnar joints. These bones are connected to each other by an interosseous membrane ( interosseous membrane) of the forearm, which consists of dense and strong connective tissue fibers that fill almost the entire gap between the bones of the forearm along its entire length.

What types of fractures can occur in the forearm?

Fractures in the forearm can occur either as a result of a fracture of the radius or as a consequence of a fracture of the ulna. There are also simultaneous fractures of both bones. Depending on the number of fragments, all fractures can be simple or comminuted. In simple fractures, in the area of ​​the fracture there are two broken sections of bone, bounded by a fracture line. Simple fractures can be transverse ( the fracture plane is perpendicular to the bone diaphysis), oblique ( the fracture plane is not perpendicular to the bone diaphysis), helical ( spiral-shaped).

In comminuted fractures, two broken sections of the damaged bone are bounded by one smaller bone fragment ( a piece of debris), which is located between them like a wedge. With comminuted fractures, there may be several small fragments. Thus, with comminuted fractures, at least three bone fragments are formed.

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

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

Fractures of the proximal segments of the bones of the forearm

Proximal fractures ( upper) segments ( after all) forearm bones are divided into three main groups. The first group includes fractures of the radius or ulna ( or both at once), which are localized below the articular capsule of the elbow joint. Such fractures are also called extra-articular fractures. The second group includes intra-articular fractures of the forearm bones. The third group includes combined fractures of the forearm bones. In these cases, both bones are damaged at the same time, with one of the forearm bones breaking outside the joint, and the other inside the cavity of the elbow joint.

Types of fractures of the proximal segments of the forearm bones

Fracture type	First type of fractures	Second type of fracture	Third type of fracture
Extra-articular fracture
Intra-articular fracture of one bone			An intra-articular fracture of one bone and an extra-articular fracture of the other.
Intra-articular fracture of both bones	A simple fracture of both bones.	A comminuted fracture in one bone and a simple fracture in the other bone.	Comminuted fracture of both bones.

Fractures of the distal segments of the forearm bones

Fractures of the distal ( lower) segments ( after all) forearm bones are also divided into three groups. The first group includes extra-articular fractures of the radius and ulna, that is, those fractures that occur at their lower ends to the point of attachment of the wrist joint capsule. The other two groups include intra-articular fractures that occur inside the wrist joint. They, in turn, are divided into complete and incomplete fractures.

An incomplete fracture is different from full of topics, that with it the fracture occurs not in the transverse direction, but in the longitudinal direction. Thus, with an incomplete fracture, the bone fracture line passes through the epiphysis without completely disrupting the contact between the articular surfaces of the wrist joint. The area of ​​the epiphysis ( where the fracture occurred) is not separated in this case, but remains connected to the diaphysis. Among intra-articular fractures, so-called metaepiphyseal fractures may appear. These are fractures in which a violation of the integrity of the bone occurs in the area of ​​the metaphysis and epiphysis of the bone.

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

Fracture type	First type of fractures	Second type of fracture	Third type of fracture
Extra-articular fracture	Isolated fracture of the ulna.	Isolated fracture of the radius.	Fracture of the ulna and radius.
Incomplete intra-articular fracture	Sagittal fracture ( a fracture that bifurcates the bone into right and left halves) radius.	Fracture of the dorsal edge of the radius.	Fracture of the volar edge of the radius.
Complete intra-articular fracture	Metaepiphyseal simple and intra-articular simple fracture.	Metaepiphyseal comminuted and intra-articular simple fracture.	Intra-articular comminuted fracture.

Fractures of the diaphyseal segments of the forearm bones

Fractures of the diaphyseal ( average) segments ( plots) forearm bones are divided depending on the type of fracture and the bone that is damaged. In diaphyseal fractures, three types of fracture can occur: simple, comminuted and complex. The first two types of fractures were discussed a little higher. Complex type a fracture is generally similar to a comminuted fracture, only in this case the number of bone fragments becomes more than one. They ( fragments) can take irregular shape and orientation in space, which significantly complicates their reposition ( restoration of bone structure).

Types of fractures of the diaphyseal segments of the forearm bones

Types of fracture	First type of fractures	Second type of fracture	Third type of fracture
Simple fracture	Fracture of the ulna only.	Fracture of the radius only.	Fracture of the ulna and radius.
Comminuted fracture	Fracture of the ulna only.	Fracture of the radius only.	Fracture of both bones.
Compound fracture	Fracture of the ulna only.	Fracture of the radius only.	Fracture of the ulna and radius.

When bones are fractured in the forearm, displacement of the fragments relative to each other can very often occur. This can happen either as a result of the action of the traumatic agent that caused the fracture, or as a result of pathological muscle contraction due to severe pain at the fracture site. As a result of this contraction, the muscles pull the bone fragments in different directions, which causes their displacement. Displacement of bone fragments during fractures of the forearm bones can occur in width, length and at an angle.

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

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

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

With the third degree of displacement of bone fragments in width, their displacement in length is often found. In such cases, bone fragments are displaced relative to each other not only in the transverse direction, but also in the longitudinal direction. This often leads to deformation and partial shortening of the forearm ( especially if both bones are fractured at once).

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

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

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

Main signs of a forearm fracture

The main symptoms of a forearm fracture always depend on its location. With fractures of the radius or ulna in their upper parts, a significant part of the symptoms are associated with disruption of normal mobility in the elbow joint. Violation of the integrity of the bones of the forearm in the area of ​​their lower epiphyses and metaphyses leads to restrictions in mobility in the wrist joint. Fractures of the diaphyses of the radius and ulna are accompanied by classic signs of a fracture of tubular bones ( the appearance of swelling, pain, disruption of bone continuity, etc.), which arise in the middle of the forearm.

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

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

Fractures of the upper ends of the forearm bones

When the olecranon process of the ulna is fractured, sharp pain occurs in the elbow joint. It is especially pronounced in the area of ​​the olecranon when palpated. The pain often intensifies with various movements ( flexion, extension, rotation) in the elbow joint. Sometimes these movements are severely limited. The elbow joint is almost always swollen ( in some cases there may be no swelling of the joint). The cause of its swelling is often hemarthrosis ( accumulation of blood in a joint) or inflammation of the articular tissues that develops with such a fracture.

Swelling is also observed in the area of ​​the olecranon process of the ulna. Here it is more pronounced. Passive movements of the elbow joint are usually possible but painful. Active flexion at the elbow is possible, but extension ( active) is often broken ( especially with a displaced fracture) and very painful. When palpating in the area of ​​the olecranon, one can often detect a recess between broken bone fragments. When the olecranon is fractured and displaced, deformation of the elbow joint often occurs.

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

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

Fractures of the diaphysis of the bones of the forearm

Diaphyseal fracture ( middle part) of the radius without displacement of bone fragments is characterized by a rather poor clinical picture ( pain, slight swelling on the outer side), due to the fact that it is localized deep in the muscles. Therefore, such a fracture is quite difficult to diagnose without radiography. When the middle section of the radius is fractured with displacement of the fragments, quite pronounced pain and swelling appear at the site of injury. Deformation of the forearm also occurs there, and crepitus is often detected ( the crunching sound that occurs between broken bone fragments when they rub against each other), bruises ( bruises), pathological mobility ( ).

Pain at the fracture site intensifies with palpation, as well as with compression of the forearm at the site of injury from the sides ( that is, during compression). Distinctive feature such a fracture is a sharp limitation of active and passive supination ( ) and pronation ( inward rotational movements) movements in the forearm.

A fracture of the ulnar shaft is much easier to detect than a fracture of the radial shaft ( due to the more superficial location of the ulna in the tissues of the forearm). It is accompanied by the appearance of pain and swelling on the inner side in the middle of the forearm. With such a fracture, subcutaneous bleeding and displacement of fragments often occur, which cause slight deformation of the affected area of ​​the forearm.

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

When both bones are fractured, severe pain appears in the area of ​​the entire forearm ( especially in the fracture zone). Patients with such fractures often cannot move the injured arm, so they support it with a healthy limb. Active and passive movements ( flexion, extension, rotation) in the elbow joint are very limited. Sometimes the function of the wrist joint is impaired. Often with these fractures there is displacement of bone fragments. In such cases, the forearm may shorten slightly in length. At the site of the lesion, significant swelling, pathological mobility, crepitus, bruising, and deformation of the anatomical structure of the forearm occur.

Fractures of the lower ends of the forearm bones

The main types of fractures of the lower ends of the bones of the forearm are the so-called “fractures of the radius in a typical location.” These fractures are localized in the metaepiphyseal zone ( that is, the area located in the epiphysis and metaphysis of the bone) 2 - 3 centimeters proximal ( higher) the articular surface of the radius, which takes part in the formation of the wrist joint. The fracture line in such fractures is often located in the transverse or oblique transverse direction. There are two types of “typical radius fractures.” The first of these is called a Colles extension fracture. The second is called a Smith's flexion fracture.

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

On palpation ( from the palm or back) pain usually intensifies. Also, by palpation, you can identify the distal ( lower) bone fragment on back side brushes Proximal ( upper) the fragment is localized behind it, on the palmar surface of the hand. The hand and fingers are often immobilized and displaced in the same direction as the distal ( lower) bone fragment of the radius. Active and passive movements in the hand are sharply limited. Possible crepitus ( the sound of crunching between broken bone fragments) and pathological mobility ( presence of mobility of bone fragments), however, it is not recommended to check for their presence, due to the high risk of damaging nerves and blood vessels.

With a Smith fracture, the distal ( lower) bone fragment ( or debris) moves posteriorly and outward ( sometimes inwards). Proximal ( upper) the fragment is displaced anteriorly and appears in front of the lower bone fragment of the radius. A Smith fracture is observed when patients fall on a hand bent at the wrist joint, which, during a fracture, moves to the same place where the distal ( lower) bone fragment of the radius ( palmar side).

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

A Smith fracture may also be associated with an ulnar styloid fracture. This fracture is characterized by the appearance of additional pain and swelling that occurs in the area of ​​its anatomical projection. With such a joint fracture, pain and swelling become even more diffuse ( common) and cover the entire wrist joint.

Diagnosis of a forearm fracture

Diagnosis of a forearm fracture is based on clinical ( anamnesis, external examination) and radial ( radiography, computed tomography) research methods. The former help to suspect such a fracture, the latter - to confirm it and help in establishing its type, assessing the degree of its severity. Diagnostic methods They can also identify possible complications and help the doctor choose the right treatment tactics.

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

• anamnesis;
• external examination;
• radiography and computed tomography.

Anamnesis

Anamnesis is a set of questions that the doctor asks the patient when he goes to a medical facility. First of all, he asks the patient about the symptoms that bother him, how and when they appeared. This stage of the clinical examination is very important, as it helps the attending physician to suspect the presence or absence of a forearm fracture. With such a fracture, the patient can tell the doctor about the presence of certain symptoms, which, in turn, may belong to two groups of symptoms.

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

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

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

Secondly, the attending physician usually asks the patient questions regarding the causes of the fracture. Basically, he asks about the circumstances under which these symptoms appeared ( when there is a blow to the forearm area, when you fall on your hand, when there is mechanical compression of the forearm, when something heavy falls on your hand, etc.). Most often, after such circumstances, fractures of the forearm bones develop.

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

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

• Rickets. Rickets is a pathology in which there is a deficiency of vitamin D in the body, which regulates phosphorus-calcium metabolism and the completeness of bone tissue mineralization.
• Tumors of the bones of the forearm. With tumors of the bones of the forearm, the growth of pathological tissue very often occurs, which disrupts their normal anatomical structure.
• Lack of calcium in food. Calcium is the main mineral component of bone tissue. If it is insufficiently supplied with food, the body’s processes of mineralization of bone tissue in the bones of the forearm are disrupted.
• Malabsorption syndrome. With this syndrome, there is a decrease in absorption useful substances (proteins, minerals, vitamins) in the intestines due to any pathology gastrointestinal tract (chronic enteritis, intestinal lymphangiectasia, Crohn's disease, etc.).
• Endocrine diseases. At endocrine diseases very often there is a disturbance in the metabolism of phosphorus and calcium in the body, which are essential components of bone tissue. Demineralization of the bones of the forearm can mainly be observed with hypercortisolism ( strengthening the adrenal glands), hyperparathyroidism ( excessive release of parathyroid hormone by the parathyroid glands), diabetes mellitus, etc.
• Long-term use of medications. Demineralization of the bones of the forearm can be caused by long-term use of cytostatics, antibiotics, glucocorticoids, anticonvulsants etc.

External inspection

During an external examination of patients with a forearm fracture without displacement of bone fragments, one can usually detect swelling of the affected area, the presence of one or more hematomas, and limited mobility of the adjacent joint with which the damaged bone interacts. When palpating the fracture site, pronounced local pain is detected. Reliable signs ( ) in such cases are absent or very weakly expressed, so radiological studies are always necessary to confirm such a fracture ( radiography, computed tomography).

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

X-ray and computed tomography

Radiography is a method radiology diagnostics, which is based on the use of x-rays. Its use allows the patient's hand to be illuminated and displayed on an x-ray ( image obtained as a result of an x-ray examination) structure of the bones of the forearm ( radial and ulnar), their location, thickness, size, relationship with other bones ( hands, shoulders).

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

If one or both forearm bones are fractured, X-rays are taken in two mutually perpendicular projections. This allows you to examine the fracture site in more detail, identify bone fragments and the direction of their displacement. On radiographs, the bones of the forearm appear as white longitudinal formations connecting ( through the elbow joint) in the upper part with the humerus, and below - with the carpal bones ( through the wrist joint).

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

The same is used for computed tomography x-ray radiation, as with radiography. However, the technique for conducting it is completely different from x-ray examination. With computed tomography, a layer-by-layer scan of the affected area of ​​the forearm is performed, which gives much more useful information. This test is more accurate than simple radiography. It allows you to identify additional fracture lines, bone fragments unnoticed during radiography, the position and angles of deflection of all fragments, which is very important when planning and choosing treatment tactics.

What does a radius fracture look like on an x-ray?

On an x-ray, the radius appears as a white oblong formation, connected to the humerus above and to the smaller bones of the hand below ( semilunar, scaphoid). In the photo it is on the left side. It is thinner at the top and thicker at the bottom than the adjacent sections of the ulna. In the case of a fracture of the radius, one or more fracture lines can be seen in the area ( fracture), which look like dark stripes that have different thicknesses, directions and edges. These strips separate bone fragments.

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

What does an ulna fracture look like on an x-ray?

The ulna on the x-ray is located on the right. It is somewhat thicker than the radius in its upper part. The lower epiphysis of the ulna is much thinner than the epiphyseal part of the radius. On an x-ray, the ulna, like the radius, looks like a white oblong formation. In most cases, they do not differ from each other in color intensity. When the ulna is fractured, the presence of a darkened line ( fracture lines), which breaks off her bone structure. The course of the line is determined by the type of fracture ( oblique, transverse, helical). With multiple, complex and comminuted fractures, there may be several such lines. In some cases, a fracture of the ulna can cause displacement of bone fragments, as well as deformation of the longitudinal axis of the ulna.

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

With strong impacts to the forearm, there is always a high probability of fractures of the forearm bones. However, in such cases, you should not panic too much and immediately think about a fracture. Quite often, such blows can only be accompanied by a significant bruise of the soft tissues of the forearm, which, by its nature, clinical manifestations (severe pain, swelling, deformation of the forearm, limited mobility in the joints, etc.) is similar to a fracture of the forearm bones.

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

Secondly, you should not judge the severity of damage to the forearm area by clinical symptoms. Since even minor injuries to the forearm can lead to fractures of the radius or ulna, although the symptoms will be quite scarce. This happens especially often in pathological fractures, when the resistance of bones to mechanical loads is reduced due to the presence of pathology in the body associated with impaired mineralization. And, conversely, severe injuries to the forearm, in which severe clinical symptoms appear, cannot always cause fractures of the radius or ulna. This type of misjudgment often causes the patient to avoid seeing a doctor for a long time and think that the forearm injury only led to a bruise.

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

Fourthly, to be on the safe side, it is worth immobilizing ( immobilize) injured forearm. This requires a rigid, solid and straight object ( board, stick, etc.) oblong in shape, the length of which can cover the hand, the entire forearm and the elbow joint. Next, you need to place this object on the lower surface of the forearm and tightly ( but not tightly, so that after applying it to the radial artery near the wrist, its pulse can be felt) strengthen it to him ( subject) using a sterile bandage. The arm where the forearm is injured should be bent at the elbow at an angle of 90 - 100 degrees. The tilt of the forearm should be such that the patient feels minimal pain at the site of injury. If there are abrasions, scratches, or wounds that occurred along with a forearm injury, it is recommended that before immobilizing the arm, place sterile wipes soaked in some kind of antiseptic on these places ( iodine, brilliant green, alcohol, etc.).

Immobilization of the forearm will ensure minimal mobility of the bones of the forearm ( this will reduce the risk of displacement of bone fragments in non-displaced forearm fractures), will reduce the risk of pain and prevent unwanted complications ( damage to nerves, blood vessels, soft tissues, which can develop when bone fragments are displaced). After immobilization, it is recommended to apply cold to the injured forearm ( ice bag) and hang it on a hanging scarf fastened to the back of the neck. Also, after immobilization, you should try not to move your arm at the elbow and wrist joint and give complete rest to your forearm.

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

Treatment of a radius fracture

The main goal of treatment measures carried out for a fracture of the radius is to restore its normal bone structure. For simple uncomplicated fractures of the radius, to restore its anatomical structure, the doctor manually performs a reduction ( reduction), without producing any surgical interventions (except for pain relief). This type of reduction is called closed reduction. This method is less traumatic and faster compared to open reposition of bone fragments.

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

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

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

Treatment time for various types radius fractures

Type of radius fracture		Timing of immobilization ( immobilization) injured limb	Time frame for restoration of full mobility in the forearm ( after removing the plaster)
Fracture of the head or neck of the radius		14 – 21 days.	14 – 21 days.
		28 – 35 days.	14 – 28 days.
Diaphyseal fracture (middle part)radius	No displacement of bone fragments.	56 – 70 days.	14 – 28 days.
	With displacement of bone fragments.	56 – 112 days.	28 – 42 days.
Fractures of the lower epiphysis (bottom part)radius	No displacement of bone fragments.	21 – 35 days.	7 – 14 days.
	With displacement of bone fragments.	35 – 56 days.	14 – 28 days.

Treatment of a fractured ulna

A fracture of the ulna without displacement of bone fragments is treated conservatively. To do this, the damaged area of ​​the arm is immobilized using a plaster splint for 14–112 days, depending on the type of fracture. When bone fragments are displaced, doctors very often resort to open them ( ) reposition ( realignment). In some cases, these fragments can be set without surgery, this happens with very simple and minor fractures of the ulna. The table below shows the approximate timing of wearing a plaster cast and the rehabilitation time, during which the complete restoration of the lost function of the forearm that occurs after a fracture usually occurs.

Treatment times for various types of ulnar fractures

Type of ulna fracture		Timing of immobilization ( immobilization) injured limb	Time frame for restoration of full mobility ( after removing the plaster)
Fracture of the olecranon process of the ulna	No displacement of bone fragments.	28 – 35 days.	21 – 35 days.
	With displacement of bone fragments.	35 – 56 days.	28 – 42 days.
Fracture of the coronoid process of the ulna	No displacement of bone fragments.	14 – 21 days.	21 – 28 days.
	With displacement of bone fragments.	28 – 42 days.	28 – 42 days.
Diaphyseal fracture (middle part)ulna	No displacement of bone fragments.	56 – 84 days.	14 – 35 days.
	With displacement of bone fragments.	84 – 112 days.	28 – 42 days.
Fractures of the lower epiphysis (bottom part)ulna	No displacement of bone fragments.	21 – 35 days.	7 – 14 days.
	With displacement of bone fragments.	35 – 56 days.	14 – 28 days.

Treatment of a radius fracture in a typical location

For fractures of the radius in a typical location ( ) without displacement of bone fragments, after radiography, all patients are given a plaster splint to immobilize the affected area of ​​the forearm. The plaster cast should cover at least the area of ​​the arm located from the fingertips to the upper third of the forearm. For such fractures, the hand is immobilized ( immobilize) for a period of 30 – 37 days. After removing the cast, physical therapy is necessary to develop movements in the wrist joint. The duration of restoration of the function of this joint is usually 7–14 days.

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

Immediately after repositioning ( reduction) the doctor must apply a plaster splint to the injured arm ( from the upper third of the forearm to the base of the fingers on the hand). The tension of the arm should remain the same, since there is still a risk of repeated displacement of bone fragments. This tension is gradually released as the plaster dries.

In the absence of successful reduction, the presence of complex comminuted fractures, the appearance of repeated displacements, or excessive damage to the articular surface of the distal epiphysis of the radius, Colles or Smith fractures are treated surgically by osteosynthesis. Osteosynthesis is a surgical procedure in which bone fragments are connected to each other by inserting special plates or knitting needles into the radius bone, holding these fragments next to each other after their reposition. After surgical reduction, a cast is placed on the forearm.

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

Treatment of a radial head fracture

In case of a fracture of the head of the radial bone without displacement of bone fragments, they resort to conservative treatment methods, which include temporary immobilization ( immobilization) and physiotherapeutic methods of treatment. Immobilization of the limb in case of such a fracture is carried out using a plaster splint, which is applied from the metacarpophalangeal joints of the hand to the elbow joint.

Before applying plaster severe pain The patient may be given anesthesia at the fracture site. Also, before applying the plaster, the patient needs to bend the arm at the elbow joint so that an angle of 90 - 100 degrees is formed. The forearm should be in an intermediate position between supination ( outward rotation) and pronation ( inward rotation), that is, it should not be turned too outward or inward. The period of immobilization, on average, is 14–21 days from the moment the plaster is applied. After removing the plaster splint, it is necessary to carry out restorative procedures in the form of therapeutic exercises to develop movements in the elbow. The ability of the affected arm to work is restored after 42–56 days.

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

There are cases when the head of the radial bone cannot be straightened during surgery. This usually occurs with comminuted complex fractures. This serves as an indication for its removal. The head of the radius can also be removed if the damage is severe ( caused by a fracture) its articular surface.

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

Treatment of non-displaced fractures of the ulna and radius

Fractures of the ulna and radius without displacement of bone fragments are the most best view fractures from the point of view of safety for the patient, as well as the timing of restoration of the injured limb. This type of fracture is accompanied by less tissue trauma compared to fractures in which displacement occurs, since, when displaced, bone fragments often damage surrounding tissue, which often leads to damage to the nerves or arteries of the forearm.

Treatment of fractures of the ulna and radius without displacement of bone fragments is carried out by simple immobilization of the damaged limb using a plaster splint ( for a period of 8 - 10 weeks). After the cast is removed, patients are advised to undergo therapeutic exercises for several weeks to develop various movements in the forearm. Full working capacity is restored after 10–12 weeks.

Treatment of displaced fractures of the ulna and radius

For a fracture of the ulna and radius with displacement therapeutic measures are in reposition ( reduction) bone fragments and temporary immobilization of the forearm using a plaster splint. Reduction of such a fracture is usually performed surgically, less often it is done conservatively through closed reduction. It all depends on the type of fracture ( oblique, transverse, etc.), direction and distance of divergence of bone fragments, their quantity, as well as the presence of any complications ( bleeding, nerve damage, etc.).

The timing of immobilization of the injured forearm mainly depends on the location of the fracture and the degree of its severity ( on average it takes 10 – 12 weeks). After immobilization, the patient must undergo courses of therapeutic exercises for gradual rehabilitation of the lost function of the forearm. Full function should return within 12 to 14 weeks.

What are the possible consequences of a forearm fracture?

After a forearm fracture, various consequences can occur. Their appearance depends entirely on the type and location of the fracture, as well as its severity. For minor fractures ( for example, a simple closed fracture of the forearm bones without displacement), as a rule, the site of damage heals quickly and imperceptibly. Complications in such cases are extremely rare. Another thing is when fractures occur with displacement of bone fragments ( and, especially, this applies to open fractures). In such cases, various consequences usually develop.

A forearm fracture can have the following consequences:

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

Bleeding
With closed fractures of the forearm, interstitial ( internal) bleeding ( which with outside subjectively perceived by the patient as a bruise). This is usually due to the fact that bone fragments, moving in different directions, touch and injure surrounding vessels and tissues. It is worth noting that internal bleeding most often occur with closed fractures with displacement of bone fragments and very rarely with the same fractures, but without their displacement. For open tissue fractures ( including vessels) are damaged much more severely than with closed ones, because there is a pronounced displacement of fragments of the damaged bone, so in such cases there is often severe external bleeding.

Nerve damage
With fractures of the bones of the forearm, damage to the nerve trunks is common ( nerves), passing nearby them. This usually happens with open or closed fractures with displacement of bone fragments. At the time of fracture, bone fragments mechanically touch nearby nerves and cause disruption of their normal function. This is accompanied by sensory disturbances ( tactile, temperature, pain, etc.) skin at the site of the fracture and beyond, impaired mobility of the fingers, hand, numbness of the limb, blocking the function of the elbow or radial joint, etc.

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

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

Fat embolism
Embolism is the blockage of blood vessels by various bodies. It can be caused by gas bubbles ( air embolism), fat drops ( fat embolism), blood clots ( thromboembolism). Quite rarely, fat embolism can develop with fractures of the forearm bones. It occurs due to the release of fat droplets from the yellow bone marrow (a collection of fat cells located deep in the long bones), localized in the diaphysis of these bones. Fat droplets that enter the bloodstream are transported to the lungs and clog their vessels, which leads to breathing problems or a complete stop. Fat embolism can develop after severe and severe fractures of the forearm bones ( arising predominantly in their middle part), in which they are fragmented into many bone fragments.

Is surgery necessary for a forearm fracture?

For a forearm fracture, surgery is not always necessary. For simple and uncomplicated fractures, it is usually not prescribed, since in them there is no displacement of bone fragments ( or they move slightly), nerves and blood vessels are not affected. In these cases, only immobilization is used ( immobilization) of the affected limb using a plaster splint so that these bone fragments fuse together correctly.

If there is a slight displacement of bone fragments, which occurs with simple closed fractures of the forearm, before immobilizing the limb, the traumatologist resorts to their manual reposition ( reduction). Surgical interventions, as a rule, are needed in more severe clinical situations, when there is a strong displacement of bone fragments, fragmentation of a section of bone ( radial or ulnar) etc. In such situations, the doctor is simply forced to reposition the fragments intraoperatively ( through surgery).

The operation can be used in the following clinical situations:

• unsuccessful reposition ( reduction) with a closed fracture;
• open fracture of the forearm bones;
• closed comminuted fracture of the forearm;
• multiple closed fracture of the forearm ( a fracture in which breaks occur in several places in one or both bones of the forearm);
• the presence of damage to large vessels or nerves due to a fracture of the forearm;
• repeated displacement of bone fragments after successful reduction of a closed fracture;
• pathological fracture of the forearm bones;
• simultaneous fracture of the radius and ulna;
• a simple fracture of the forearm bones with displacement when the patient presented late to the traumatology department ( in these cases, improper fusion of bone fragments occurs, and the traumatologist can no longer set them by hand without the use of surgical measures).

How is rehabilitation after a forearm fracture?

After the cast is removed, many patients have to undergo so-called rehabilitation after a forearm fracture. It is necessary for the full and lasting restoration of impaired or lost functions of the forearm that arose after a fracture. Impaired functionality in such injuries is most often caused by damage to the nerves that regulate the contraction of the muscles of the forearm, and is also provoked by a disorder of microcirculation in the venous, lymphatic and arterial systems that feed these muscles.

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

The following main groups of rehabilitation measures that may be required for patients with a forearm fracture are distinguished:

• physical therapy;
• physiotherapeutic methods;
• massage.

Therapeutic exercise
Physical therapy is prescribed for most forearm fractures, regardless of their type. Physical therapy is carried out through a variety of movements ( active, passive, active-passive, etc.) in the injured limb, which the patient performs under the supervision of a methodologist ( instructor). Therapeutic exercise is necessary for the gradual development of mobility in the elbow and wrist joints, strengthening muscles, restoring their tone, returning the full range of motion in the forearm, improving blood supply, and normalizing nervous regulation.

Physiotherapeutic methods
After forearm fractures, physiotherapeutic procedures are often used. They can be electrophoresis, ultra-high frequency therapy ( UHF therapy), ultra-high frequency therapy ( Microwave therapy), inductothermy, pulse therapy, etc. These procedures have anti-inflammatory, myostimulating ( stimulate muscles), healing, vasodilating, trophic ( increased metabolism in tissues) action on the fracture site.

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

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

If you have an open fracture of the forearm, you should immediately call an ambulance ( if this is not possible, first you need to provide first aid, and then go to the traumatology department). Before the ambulance arrives, the victim must be given first aid, the essence of which is as follows. In the presence of a strong arterial bleeding (the blood is bright red and spurts from the wound) the victim needs to stop the bleeding. This is done by applying a tourniquet to the lower surface of the shoulder ( where does the brachial artery pass), thus the tourniquet should be located above the fracture site. Before applying a tourniquet, the skin should be wrapped with a rag or bandage. This will relieve the tight pressure from the tourniquet and prevent bruising.

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

Next, you need to put ( without touching the wound) several sterile swabs ( made from bandage). They can be soaked in antiseptic solutions ( alcohol, iodine, brilliant green, etc.). After applying tampons, they should be easily secured to the fracture site with a bandage. It is worth noting that placing tampons on a wound is a means of stopping severe venous bleeding ( blood is dark red). With such bleeding, there is no need to apply a tourniquet to the shoulder.

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

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

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

An injury to the ulna is a fairly serious injury that, like other complex fractures, requires more long period treatment and rehabilitation. This is due to the complex anatomical structure of the bone, its direct connection with the elbow and wrist joint.

The ulna is a paired bone tubular bone, which articulates with the radius and forms the forearm. From below it is connected to the hand, from above to the humerus. In the process of movement of the elbow joint, three processes of the ulna are involved - at the top the coronoid and ulna, and at the bottom the styloid.

Violation of the integrity of the tissues of the ulna, involved in the formation of the elbow joint, leads to immobilization of the injured limb. Thanks to the presence of the joint, the mobility of the limb is observed, important movements and actions are performed - flexion-extension, rotation inward and outward.

Symptoms of a fracture

To correctly diagnose an injury, it is enough to pay attention to the characteristic symptoms of a broken ulna:

• swelling in the elbow;
• partial immobilization of the elbow joint;
• the appearance of a hematoma at the site of injury;
• severe pain throughout the entire limb.

The cause of injury is a direct blow to the forearm or a fall on an outstretched arm, as well as increased load on bone tissue affected by a disease that disrupts the structure and reduces the strength of the bone.

Types of injuries

The fracture can be open or closed. Regardless of the complexity of the structure of the elbow joint, their symptoms do not differ from those of other fractures:

• a common type of injury is a closed fracture, in which the structure of the soft tissues is not disrupted and no wounds are formed;
• an open type fracture, on the contrary, is characterized by wounds and damage to the skin by a bone fragment. The size of the affected surface depends on the severity of the injury;
• comminuted, in terms of symptoms it is very similar to a closed fracture, but differs in the presence of fragments inside, which can be easily felt during palpation;
• a displaced fracture of the ulna (Fig. b below) is characterized by a violation of the usual contours of the limb or an unnatural position and externally visible appearance of the elbow joint;
• a crack is a violation of the structure of the bone surface and does not require long-term rehabilitation and treatment.

The easiest and safest injury is considered to be a crack or closed fracture of the ulna without displacement (Fig. a).

According to the direction of the damage contour, fractures are classified into:

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

The most rarely encountered in medical practice is an isolated fracture, similar in symptoms to a transverse one without displacement. This occurs due to the close proximity to the radius, which delays and maintains the position of the resulting fragments. For this fracture, conservative treatment is used with the mandatory use of a plaster cast, which reliably fixes the injured area.

The elbow injury is classified as a compound fracture. In case of a fracture of the ulnar and coronoid processes of the bone, surgical intervention is necessary, which is necessary and contributes to the restoration of motor functions of the limb.

A fracture in the upper part of the ulna complicated by dislocation is called a Monteggia fracture or a paraging fracture. It most often occurs due to direct impact or blow to the area of ​​the ulna.

Based on the location of the source of injury, there are:

• periarticular (metaphyseal) fractures;
• fractures of the ulna inside the joint (epiphyseal), which lead to destruction of the ligaments, joint, capsule;
• fractures in the middle section of the bone (diaphyseal);
• olecranon injuries;
• fractures of the coronoid processes of the ulna;
• damage to the styloid process located in the vicinity of the hand.

First aid

Methods and mechanisms for providing first aid depend on the type of fracture that occurs. When opened, it is necessary to protect the resulting wound from infection and stop blood loss. It is necessary to apply a sterile napkin and use a tourniquet or belt to stop the bleeding.

Moreover, you need to place a note under the tourniquet (or write it down for yourself) with the exact time of its application, so that at the right time you can loosen it for a couple of minutes. If this is not done, then due to the lack of circulation to the damaged limb, it will begin to die and it will be impossible to restore its functions. It is necessary to loosen it an hour and a half after application, and after a few minutes tighten it again.

It is important to immobilize the injured limb. To do this, use therapeutic splints or improvised means, in the form of flat boards, to which the injured hand is fixed with a rope, bandage or scarf, or scarf. Any available painkillers will help the patient get rid of acute pain. Having provided emergency care, it is necessary to refer the patient to a medical institution for subsequent diagnosis and treatment.

Treatment

Often, elbow fractures are combined with dislocation or displacement. This requires timely assistance from a specialist to increase the chance of resuming the normal functioning of the injured limb.

When the integrity of bone tissue is restored, new cells are formed, which subsequently form callus. The timing of fusion (bone tissue regeneration) is individual for each patient and depends on the patient’s age and type of fracture. In the normal course of the treatment process without complications, the period of healing of the ulna after its fracture lasts about 10 weeks.

In some cases, the fracture is accompanied by damage to the styloid process, located in the lower part of the ulna. Then a closed comparison of the fragments occurs and plaster is applied for tight fixation. The procedure takes place under local anesthesia.

In case of an isolated fracture with or without displacement, a plaster splint is applied from behind. In this case, a third of the shoulder should be covered, and the plaster bandage should go down to the wrist joint. The duration of immobilization is about 1 month. To carry out rehabilitation measures, the splint is removed from the second week. Therapeutic exercises and hand movements are carried out with extreme caution. After which the bandage is put on the arm again.

In fractures with complications, the patient requires surgical intervention. Its necessity is determined by the doctor based on an x-ray examination, which accurately determines the location of the damage, the number of fragments, and also cleanses the soft tissues from stuck small fragments of the damaged bone. The operation is performed under local or general anesthesia. The method of pain relief is selected individually and depends on general condition patient's health.

A Monteggia fracture is difficult to treat and in some cases can cause complications. It is characterized by:

• slow fusion or complete nonunion of the ulna,
• connection of the ulna and radius;
• curvature of the ulna due to malunion;
• displacement of the head of the radius.

To avoid complications and increase the possibility of successful recovery and restoration of hand function, you need to start treatment immediately.

Rehabilitation

During the recovery period after an injury, a number of measures are taken to restore the functioning of the injured limb and normalize blood circulation. There are a number of methods that are carried out under the supervision of a rehabilitation physician.

• To reduce pain, the patient undergoes physiotherapeutic procedures using high-frequency electromagnetic fields and modeling currents. Later, electrophoresis is used.
• Massage will improve blood circulation. A physical therapy complex, selected individually, will quickly restore the sensitivity and function of the limb impaired due to injury.
• Medical procedures such as ozokerite, paraffin therapy, and thermal baths are also indicated. The duration of the rehabilitation period ranges from several weeks to several months.
• During the rehabilitation period, an important factor is a balanced diet, enriched with calcium-containing products - milk, cottage cheese, cheese, etc.

Consequences

The patient’s recovery, the healing of damaged bone tissue, and subsequently the quality of his life largely depend on the qualifications and experience of the doctor involved in the treatment of injury. The upper limb is an important component of the human skeleton. Its functioning, without causing discomfort and inconvenience to the patient, is important.

Ignoring doctor's orders during the treatment process or refusing rehabilitation measures can negatively affect natural functions, lead to the patient's disability or partial loss, and limitations in fulfilling the role assigned to it.

Prevention of fractures

To avoid serious fractures, you need to constantly train the ligaments and joints of your hands. To do this, you need to perform physical exercises with loads. Several times a year, preferably in spring and autumn, you need to take vitamin complexes that will compensate for the lack of useful elements in the body.

The elbow joint is an important anatomical formation that unites the bones of the shoulder and forearm. If it functions with disturbances, then difficulties arise in performing the simplest movements. A person experiences discomfort while eating, combing, lifting weights, or grasping any object. When the elbow joint moves, the bones of the forearm, wrist, and phalanges simultaneously move and rotate in space. Only due to the normal functioning of the joint we can perform complex movements with the hand.

When the bones that form it are fractured, the functions of the entire arm are limited. Obstacles arise when trying to perform any basic movement, for example, turning the hand upward. Complete restoration of the functions of the elbow is possible only when the bones and their fragments are placed in an anatomical position, ensuring their rapid fusion. The leading method for diagnosing all fractures of the elbow joint is radiography. The treatment method depends on the location and severity of the injury, and the age of the patient. If conservative treatment (plaster application) does not have an effect, the patient is prepared for surgery.

A little anatomy

The elbow joint is formed by the ulna, humerus, and radius bones. The elbow is formed by two joints. When the bones of the shoulder and forearm join, the first is formed; Thanks to him, the elbow bends and extends. The second articulation is formed by the ulna and the smooth head of the radius. During movement in the joint, the ulna rotates around the radius. The main functions of this joint:

• supination, or turning the hand with the palm up;
• pronation, or turning it palm down.

The lower third of the humerus has a complex shape. Her central department slightly above the elbow it is divided into two parts that support the condyles. They can be detected by palpating the soft tissues located to the right and left of the elbow joint. In the area with the condyles there is a certain number of projections and grooves in which the ends of the bones are located. In these anatomical structures they articulate and move relative to the shoulder bone.

The bone surfaces are lined with durable and at the same time elastic hyaline cartilage. It is white, smooth, slippery, and protects against damage to the bones, which often and monotonously shift in the elbow joint. Smooth and painless movements are provided by cartilage tissue. Unlike other anatomical elements of the body, they are practically not supplied with blood. Synovial fluid serves as a source for them:

• molecular oxygen;
• nutrients and biologically active substances.

In most cases, cartilage is damaged during a fracture. For its further functioning, a jewelry reposition (comparison, alignment) of fragments is needed.

The main goal of therapy for any fracture is to restore the articular surfaces. If complete regeneration of cartilage tissue does not occur, the risk of irreversible complications increases significantly.

Traumatologists treat so-called post-traumatic arthrosis - a degenerative-dystrophic pathology that provokes ankylosis (complete or partial joint immobility). Fractures of the heads of the radial bones of the elbow joints are very dangerous. Blood circulation in this part of the elbow is completely disrupted. With nutrient deficiency, there is a high probability of irreversible destruction of the bone head.

Clinical picture

During a fracture, acute pain occurs. One of the leading symptoms of injury is a crunching sound, reminiscent of the cracking of dry branches being broken. Pain is usually localized on the back of the joint. The following signs are also characteristic of the injury:

• pain radiates to the shoulder and forearm;
• a few minutes after the injury, swelling begins to form, the intensity of which quickly increases;
• the skin in the area of ​​injury is cool, pale, sometimes bluish;
• the hematoma forms a little later. First, pinpoint hemorrhages occur due to ruptured large vessels. Gradually, blood pours into the subcutaneous tissue and an extensive hematoma appears on the front surface of the elbow;
• with an open fracture, the skin is damaged, and bone fragments and sharp edges of tubular bones may protrude from the wound;
• the victim is unable to move the injured arm - bend and straighten the elbow, and rotate the hand.

Usually the elbow is deformed. Often the pain is so severe that the patient may lose consciousness. Upon palpation, the doctor detects large fragments and assesses the severity of the injury. The symptoms of a crack in the elbow joint are not so pronounced. A large hematoma forms, the area of ​​damage swells, but movement is not limited. The victim holds the injured arm with the healthy one to reduce the intensity of the pain.

Types of elbow fractures and treatment methods

The elbow joint is a stable anatomical formation due to the presence of elastic ligaments located on both sides of the joint. Traumatologists very rarely diagnose elbow dislocations due to its strong ligamentous-tendon system. Stability is ensured by both strong double-headed and triceps muscles, crossing joints. A person is able to bend the elbow due to the secure attachment of the biceps to the radius. And the triceps, which is attached to the process of the elbow, is responsible for extension. As a result of such a complex anatomical structure, victims experience a variety of fractures.

A blow or fall can cause cracks in the elbow joint. They can be single or multiple, and according to their location to the bone axial line - linear, oblique, spiral-shaped. When there are cracks in the bone, the joint retains its supporting function. If they are not accompanied by a fracture, then wearing a plaster cast is sufficient for a complete recovery.

Fractures of the lower humerus

A fracture that does not affect the articular surfaces is called extra-articular. Once diagnosed, the prognosis for full recovery is favorable. Extra-articular injuries are detected slightly above the elbow, usually in the area of ​​the epicondyles. Even applying a plaster cast does not immobilize the joint well, so surgery is performed immediately. The doctor compares the fragments in anatomical position and secures them metal plates and screws. The shape of surgical devices follows the curves of the bones. This ensures stable fixation and rapid healing of the fracture. An operation performed using this technique allows the victim to begin developing movements earlier.

A common injury to the elbow is a separation of the medial epicondyle, accompanied by its fracture, due to excessive traction of the collateral ligaments. A bone fragment is detached, entering the joint cavity and completely blocking movement. An attempt to bend or straighten the elbow leads to severe, piercing pain. An open operation with fixation of the bone fragment to the avulsion site is indicated. Sometimes it is possible to restore the articulation using a conservative method, but only if the fragment is located near the place where it was torn off.

If an intra-articular fracture is diagnosed, the prognosis for complete recovery is worse. The goals of therapy are high-quality alignment of fragments and restoration of cartilaginous surfaces. The most commonly diagnosed injuries are:

• fractures humerus in the area of ​​their capitate elevations. The fragments move inside the joints, limiting their functioning. Injury often occurs from a fall with emphasis on an outstretched arm or from a dislocation. Surgical therapy is indicated for patients. Large fragments are secured with screws in the correct position. Small fragments that cannot be reduced are removed;

• transcondylar and intercondylar injuries. These are the most commonly diagnosed types of fractures, usually occurring with strong impact at the elbow. Supporting epicondyles bone structures are destroyed, which causes a change in the ratio of bones. Such injuries are characterized by serious damage to cartilage tissue, the restoration of which is a difficult task. After repositioning the articular elements, they are secured with screws and plates until they are completely fused. This will not be a limitation for the gradual development of the joint.

More details

During diagnosis, the condition of the blood vessels and the degree of hemorrhage in the joints are assessed. During the operation, the surgeon also has to restore the damaged nerves. If this stage is neglected, severe complications will develop. Disruption of innervation will provoke loss of sensitivity in the hand, and a significant decrease in the range of motion in the elbow is also possible.

Fracture of the proximal ulna

With such injuries, the damage is usually localized in the upper thirds of the ulna bones. A fracture of the olecranon occurs (Montaggi fracture-dislocation).

If a fragment is displaced due to triceps traction, then only surgical treatment is performed. The surgeon restores cartilage and bone tissue, and then fixes the fragments with knitting needles and wire. The pins are removed approximately six months after assessing the condition of the elbow. And the plates are removed later - after 1-2 years.

Treatment of joints Read more >>

Due to the close location of the olecranon process to the skin, the operation does not last long and is not difficult. But there are exceptions - comminuted fractures with damage to the coronoid processes. They are secured with special surgical metal structures.

Fracture of the neck and head of the radius

When a person breaks his arm at the elbow joint, he loses the ability to rotate the radius. This leads to a decrease in the functional activity of the forearm. The victim also cannot turn the hand or grasp any object. Sometimes bone fragments are displaced into the joint cavities, blocking movement. A dangerous complication of injury is damage by bone fragments to the blood vessels responsible for the trophism of the radius. If the fragments are slightly displaced, the operation is not performed. The functions of the elbow are restored when a plaster cast is applied. If the fragments blocked the articulation, then they are internally fixed with screws and plates. In case of a comminuted fracture, the patient is indicated for endoprosthetics of the bone head.

The bones that form the elbow joint are located close to the surface of the skin, so open fractures are often diagnosed. With such injuries, several elements located inside the joint are damaged at once. For an open fracture, surgery is performed. Damaged, contaminated tissue at the site of the skin break is excised, and then the bones are secured with external fixation devices. Once the wounds have healed, the device is removed. Now the bones are attached with plates and screws, which are removed after the functions of the arm are fully restored. This method of surgery reduces the likelihood of infection of the joint cavities with pathogenic bacteria.

The effectiveness of therapy depends on timely seeking medical help. The victim’s hand should be secured with a bandage in the form of a scarf, a cold compress should be applied to the area of ​​swelling for 10-15 minutes every hour, and a tablet of Nurofen, Diclofenac, Nise or Ketorol should be given. The person should be taken to an emergency room as quickly as possible for evaluation and treatment.

How to cure a shoulder fracture?

The shoulder joint, made up of several different types of bones, is one of the most complex joints in the human body. Naturally, a fracture of this joint is also difficult not only to diagnose, but also to treat. This is explained by the large number of structures involved in the composition of the joint.

Despite the complexity of the joint, its fracture is quite rare in medical practice. This is due to the anatomical location and movement patterns in this area. Basically, fractures occur if the joint has been subjected to some strong external force. However, as doctors say, simple exposure is rarely enough; bone structures must already be affected by some pathological process in order to respond to contact with the influencing factor with destruction.
Content:

• Signs
• Symptoms
• Fracture treatment shoulder joint
• Rehabilitation. Development of the shoulder joint
• Exercises and massage

Signs

Of the signs that even a person without medical education, it is worth highlighting the appearance of a hematoma in the area of ​​​​the projection of the joint. A hematoma appears due to trauma to blood vessels and blood entering the area of ​​the joint capsule. However, a hematoma is not only a sign of a fracture, and therefore its presence is rather simply a sign of injury.

Another sign of a fracture that may strike the eye of a person who does not have a medical education is a change in the silhouette of the limb. A change in the silhouette of the limb in the shoulder area when a joint is fractured occurs if the bone fragments are displaced at one angle or another. A change in the silhouette in most cases indicates a fracture, while other characteristic symptoms may indicate other types of injuries or pathologies.

Naturally, if a person has developed an open fracture of the shoulder joint, this will immediately catch the eye of even an inexperienced person. In case of an open fracture, the most important thing is not to try to force bone fragments into the wound yourself. This should be done by specialists.

Signs of a fracture of the shoulder joint are often blurred, and therefore present diagnostic difficulties even for an experienced doctor. If a person has reason to suspect a fracture in this particular area, it is recommended to immediately call an ambulance followed by hospitalization of the patient.

If a fracture of the shoulder joint is suspected, it is recommended to limit the sick person’s mobility in the area of ​​the injury so as not to provoke a worsening of the situation.

Symptoms

Symptoms that may indicate a fracture in the shoulder joint are usually quite difficult to ignore. These include:

• severe acute pain in the damaged area of ​​the body with irradiation into nearby tissues, intensifying with movement;
• deformation of the shoulder silhouette if the patient has developed a fracture with displacement of the fragments;
• mobility in the hand is severely limited or completely absent due to severe pain (in some cases, it is even possible to develop pain shock if a person has reduced sensitivity to pain);
• in the area of ​​the hand, shoulder and forearm, a pathological disturbance of sensitivity associated with trauma to nerve fibers may develop;
• Severe swelling in the area of ​​the fracture can also deform the silhouette of the joint, but it usually does not develop immediately, but several hours after the injury;
• a hematoma developing in the affected area can spread over fairly large surfaces, sometimes even reaching the area of ​​the hand;
• Below the fracture site, the patient may feel an unpleasant tingling or numbness associated with trauma to blood vessels and nerve fibers;
• If the head of the joint is involved in the fracture, then during movements a characteristic bursting sound may appear - crepitus.

The diagnosis of a fracture is made based on the results of collecting anamnesis, complaints and evaluation of radiographic images.

Treatment of a shoulder fracture

Treatment for a shoulder fracture begins only after an x-ray has been taken and the diagnosis of the fracture has been confirmed. Thanks to radiography, the optimal treatment method is established.

Therapy for a fracture is divided into surgical and conservative. For fractures in the shoulder area, conservative treatment is allowed. It is performed if there is no displacement of bone fragments and the configuration of the joint is not disturbed. In this case, the joint is forced into a plaster splint, and the patient is advised to rest. An important element of treatment is the need to protect the injured limb from unnecessary stress. The bandage is applied for up to one and a half months.

If the patient is diagnosed with a displaced fracture, then he undergoes reduction of the fragments. Reduction is always performed under anesthesia. If the injury is very serious, then surgical fixation of the joint elements is possible using screws, knitting needles, plates and other elements designed to maintain bone fragments in normal positions.

Complex fractures require longer recovery time (from 2 to 4 months or more). In addition, if fixing elements were used in the treatment, it will be necessary to remove them several months after the joint has fully recovered.

During treatment, the patient is also prescribed painkillers, anti-inflammatory drugs, vitamins, calcium and phosphorus preparations, designed to improve bone strength and stimulate fracture healing.

Rehabilitation. Development of the shoulder joint

During the treatment period, the patient's arm is fixed in one position to avoid new fractures and promote the healing of bone fragments. Such fixation for a long time negatively affects muscle tissue, tendons and joint mobility.

After the bones have fused and the splint has been removed, the patient is recommended to begin rehabilitation measures aimed at developing the shoulder joint and restoring mobility to it. Often, development exercises can be accompanied by severe pain, for the relief of which painkillers are used.

It is important to realize that the presence of pain during joint development is not a reason to stop the rehabilitation course. On the contrary, pain helps doctors and the patient to navigate and correctly carry out measures aimed at restoring mobility.

Shoulder development is carried out under the supervision of a specialist. It is important that the attending physician monitors the process and adjusts it as necessary. It is also the doctor’s responsibility to order periodic x-ray examinations. Regular x-rays help monitor the progress of rehabilitation and adjust it if it is not beneficial or is making the situation worse.

Exercises and massage

Rehabilitation of a person with a fracture of the shoulder joint occurs in several stages. In the first days after the injury, he is given recommendations regarding minimal movements in the fingers of the injured limb. Swelling may make this difficult.

• raising the shoulder area;
• bringing the shoulder blades as close to each other as possible, and then spreading them apart, adopting a hunched position;
• flexion and extension movements in the forearm;
• flexion and extension movements in the shoulder area, performed with a small amplitude;
• circular or pendulum movements of the arms, carried out from a standing position;
• with caution and after permission from a specialist, you can throw your injured arm behind your head;
• joining the hands in a lock at chest level and then separating them.

Exercises from the given complex should be performed with caution and gradually. If any exercise causes too much inconvenience, it is better to abandon it for a while.

In addition to exercises, massage plays a great role in the rehabilitation of a person with a fracture of the shoulder joint. Before using this restorative technique, it is recommended to consult a doctor. Massage can be started only when partial mobility of the joint has already been restored. Thanks to this, it will be possible to avoid new injuries in the damaged area and alleviate the patient’s condition.

Massage will help not only stimulate the healing of the injury, but also partially develop the area of ​​​​the damaged joint. Its combination with gymnastic exercises carried out regularly, gives a good effect and allows you to quickly restore mobility.

The shoulder joint is like one of the complex structures of the human body, requires increased attention to itself in case of any injuries. Incorrect treatment or failure to follow rehabilitation recommendations may result in the patient losing the ability to move the injured limb. The task of a traumatologist, and then a rehabilitation specialist, is to prevent such an outcome, which is why rehabilitation techniques are used.

The patient, in turn, must realize that restoring joint mobility is only in his hands. If he does not take care of his own health, then doctors, even if they want, will not be able to help him.

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