Fracture of the 3rd ulna. Signs and treatment of an ulna fracture. Treatment for forearm fractures

A fracture of the elbow joint is a common injury in both older people and young people who lead an active lifestyle, play sports or hike. The elbow joint has a complex structure and does not always give significant symptoms when fractured. However, it should be understood that recognition of injury and competent first aid are decisive measures for effective treatment and complete rehabilitation.

Photo 1. Most often, a fracture of the elbow joint occurs as a result of a fall. Source: Flickr (stephanie beamer)

The structure of the elbow joint

The human hand is a unique biological mechanism that has a complex structure. The hand is divided into:

brush
forearm- from hand to elbow (elbow joint)
shoulder- this is the part of the arm from the elbow to the place that is popularly called the shoulder, to the shoulder joint
above the shoulder joint (where the collarbone is in front and the scapula is behind) located shoulder girdle.

Thus, the elbow joint connects the forearm and shoulder. In it, three large bones converge and are attached to each other, through tendons, muscles, ligaments, connective tissue and a special shape:

one humerus
two bones of the forearm - the radius and ulna.

These bones are held together to form the movable structure of the elbow joint:

from the side of the radius – radial collateral ligament
from the outside ulna– ulnar collateral ligament
from the muscles – biceps tendon
on the side of the shoulder bone - medial (internal) and lateral (external) epicondyles (epicondyle is a thickening of the end of the bone to which muscles and ligaments are attached).

Note! An elbow fracture is said to occur when there is a fracture of the upper part of the forearm bones, the radius or ulna, or the lower part humerus.

Causes of elbow fracture

You can break your arm at the elbow:

when falling on a bent or straight arm
getting hit along the arm in the area of the elbow or forearm.

Types of Elbow Fractures

All elbow fractures can be divided into:

Elbow fracture with triceps tendon rupture or intra-articular fracture(is the most common elbow injury).
Fracture of the head and neck of the radius without rupture of the triceps tendon. Here a slight displacement of bone fragments is possible.
Fracture of the coronoid process.
Broken arm in the elbow with displacement and fragments. As a rule, this is a fracture of the process of the ulna (the bone that we feel when we feel the elbow).

Children and adolescents are characterized by Fractures of the epicondyles of the humerus with separation of the joint from the tendon. They often receive such injuries as a result of arm dislocations during team sports games. Adults can receive a similar injury as a result of a direct blow to the medial epicondyle.

Symptoms of an arm fracture in the elbow joint

You can suspect an elbow injury based on the following, which occur immediately after force on the arm:

Sharp pain, which can radiate down along the arm along the entire forearm into the hand
Inability to move the arm freely, bend and straighten it
Tissue swelling in the elbow area, discoloration of the arm
Neurological symptoms in combination with pain - numbness, tissue tingling
Non-physiological mobility of the arm at the elbow (the arm moves from the elbow not only up and down, but also from right to left)
Feeling of “irregularity” in the structure of the elbow during palpation in comparison with a healthy arm
Crunch, “grinding” of bone fragments.

For children with such an injury, a crying reaction is typical, with the arm lowered along the body. The child tries to support her with his healthy hand. It is possible to find a comfortable body position to reduce pain. The baby is restless, excited, complaining about his hand.

Note! An elbow fracture is not necessarily associated with loss of arm motion, significant swelling, or palpable displacement. If there is any sharp pain in the arm after a fall or blow, the limb should be immobilized and the victim should be shown to a specialist.

First aid - how to act correctly

Despite the fact that there are many possible options for a fracture of the elbow joint, it is the same in all cases. Effective pre-medical measures come down to three principles:

Anesthetize
Handle
Immobilize (immobilization).

Anesthesia

In case of traumatic injury to a limb, the patient should be given in tablets or given an injection. It could be:

Analgin, Baralgin or analogues
Ketanov
Nise.

The use of analgesics may slightly weaken pain syndrome. However, in severe cases this is ineffective.

Note! Increasing the dose of analgesics does not increase the analgesic effect, but may have Negative influence to the liver.

Treatment

Injured skin, if any, should be treated with an antiseptic. In case of an open fracture, you should:

Stop bleeding, which is possible due to vascular injury. This is done by applying a tourniquet or tight bandage above the wound with mandatory recording of time
Treat the edges of the wound
Apply an antiseptic bandage (with sterile materials).

Photo 2. Antiseptic and bandage are essential items in case of injury. Source: Flickr (DLG Images).

Fixing a limb in a stationary position

When the elbow is fractured, the arm is fixed in a scarf and suspended from the neck. The principle is as follows:

hand to elbow should be parallel to the floor (bent at a right angle) and with the palm facing the body
hand in a bandage should be completely relaxed and lie in it “like in a cradle.”

A cloth folded in several layers should be placed under the bent arm (this could be the clothing of the victim or the person helping). It is necessary to fix the limb in this position using a wide (the entire length of the shoulder and hand) bandage.

What not to do:

you cannot straighten the limb along the body
you can't try to fix the injury
cannot be fixed injured limb with a thin cord - this will not provide the necessary immobility.

Note! If the desire to bend the arm causes severe pain in the victim, then the limb should be left in the position it took after the injury, taking possible measures by its immobilization.

Diagnosis of a fracture

Diagnostic procedures begin with inspection damage, damage palpation And x-ray. An X-ray is an accessible, informative method of hardware diagnostics.

If a simple x-ray is insufficiently informative, use computed tomography – X-ray in several projections using (if required) a contrast agent. This method is more accurate compared to the simple one x-ray. It allows you to see more accurately the location and nature of the damage.

The most accurate, but not always accessible method diagnostic study for fractures is magnetic tomography. With its help, visualization of damage not only to bones, but also to soft tissues (ligaments, muscles, blood vessels) is possible.

Note! X-rays are not given to pregnant women. Magnetic tomography is prohibited if there are metal implants or fragments in the victim’s body.

Treatment of elbow fracture

Treatment options for an elbow fracture vary depending on the injury.

Treatment for non-displaced fractures

If a fracture in the elbow joint occurs without displacement of the bones, then therapeutic measures consist in fixing a limb in a stationary position until the damaged bones heal naturally. A splint is placed on the arm. The length of time you wear it depends on which bone is damaged.

A fracture of the neck of the radius heals in 2-3 weeks
Fracture of the coronoid process requires immobility for 3-4 weeks
Any displaced fracture is fixed for 4-6 weeks.

Treatment of a displaced fracture

If the bones are displaced, there are bone fragments or an open injury, then surgery needed. A patient with an open fracture must be operated on on the first day. During surgery, the surgeon reassembles the displaced bones, restoring the integrity of the joint.

In case of bone fracture (an injury typical for elderly patients), prosthetics and replacement of the joint or its parts are performed. A graft (part of the victim’s or donor’s bone) or an implant (an artificial “spare part”) are implanted. After surgery, the arm is fixed for healing in the same way as with a “simple” fracture.

Note! In children, due to faster metabolic and regenerative processes, the healing time of damaged bones is reduced.

When treating childhood fractures, instead of plaster immobilization, the method of surgical osteosynthesis is used. Its essence is to connect fragments of bone parts with special fasteners - knitting needles, bolts, pins. This allows you to maintain mobility of the joint itself (which is extremely important for children) and reduces the possibility of complications.

Drug treatment of an elbow fracture

Drug treatment is carried out in several directions. This:

Anesthesia. Carried out as needed. Non-narcotic analgesics can be used on an outpatient basis. Narcotics – exclusively in a hospital setting
Non-steroidal anti-inflammatory drugs prescribed to relieve swelling and reduce pain
Antibiotics used in 90% of cases for displaced injuries. Always with open fractures
When open injury must be carried out antitetanus therapy.

Consequences of a fracture of the elbow joint

The consequences of a fracture of the elbow joint are divided into post-traumatic (postoperative) and long-term.

Post-traumatic consequences of an elbow injury include:

Bleeding. The occurrence of bleeding is high with an open fracture or a displaced fracture, where damage may occur blood vessels. Bleeding may occur from the bone or after surgery.
Thrombo or fat embolism. There is a possibility of fat cells or blood clots entering the bloodstream when soft tissues and blood vessels are damaged. Embolism is a life-threatening condition.
Development of infectious processes.
Tetanus.
Displacement of bone fragments, their incorrect fusion.

Long-term consequences include:

Impaired motor function of the hand
Improper fusion of the joint
Rejection of “replaced” bone parts
Pain, numbness of the limb
Development of arthrosis ( degenerative changes joint).

Note! If the treatment of post-traumatic consequences is the prerogative of doctors, then the prevention of long-term consequences is 90% the work of the patient. Compliance with doctors' recommendations, full implementation rehabilitation activities depends on the patient.

Rehabilitation

The rehabilitation period allows you to carefully, under the supervision of a specialist, bring the elbow joint into a working position, restore strength to the muscles of the arm, and restore the former elasticity and mobility to the tendons and ligaments. Without a quality one, you can lose some of the capabilities of the injured limb.

Duration rehabilitation period after a fracture of the elbow joint depends on the severity of the injury and the method of its treatment. The use of surgical osteosynthesis allows you to begin rehabilitation therapy as early as 3-4 days after surgery. When applying a cast, all rehabilitation comes down to moving your fingers - you can’t do more with a cast on your arm. Here, full rehabilitation will be possible after removing the bandage.

Photo 3. Rehabilitation of the limb should begin while wearing a cast.

The elbow joint is formed by several bones at once. And the mechanism of its movement is very complex, despite the fact that this movement is carried out in only two planes. Serious complications often arise from a fracture of the elbow joint. This is due to its complex structure and the fact that large vessels and nerves pass through this joint. If the latter are damaged, serious and very unpleasant consequences.

Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

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

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

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

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

IN medical practice Joint injuries are quite common. A fifth of all intra-articular fractures are fractures of the elbow joint. You can break one or more of its bones with direct trauma- falling on the elbow, hitting. The cause of the fracture may be indirect mechanism exposure due to sudden rotation of the arm, excessive extension, this can happen in everyday life, at work, during car accidents and playing sports.

Classification

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

In relation to the external environment:

Closed, without damaging the skin.
Open, with a wound, communicating with the external environment.

In relation to the joint cavity:

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

According to the nature of the damage:

Without displacement of fragments, including a crack (incomplete fracture).
With displacement of fragments.
Shrapnel with the formation of bone fragments.
Crushed with bone crushing.
With a dislocation in the joint - fracture-dislocation.
With ruptured joint ligaments.
With damage to the synovial membrane.

By localization:

Epicondyles of the humerus - medial (internal), lateral (external).
Condylar - transcondylar fracture of the distal epiphysis of the humerus.
Coronoid process of the ulna.
Heads of the radius.
Radial necks.
Olecranon process.
Combined – 2 or more bones.

Symptoms

Clinical manifestations vary depending on the location of the injury.

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

Signs of damage to the coronoid process is pain localized in the area of the ulnar fossa, palpation is painful, the arm cannot bend completely, but it can be straightened. With a fracture of the head and neck of the radius external changes not typical, painful palpation, movement, rotation in the joint. The pain may not be pronounced and aching in nature, so such fractures may not be detected for a long time and may be mistaken for a sprained joint.

For fractures of the condyles and epicondyles of the shoulder local swelling, hematoma and deformation of the joint are noted, movements are limited due to pain, and a symptom of crepitus is often detected - a crunching sound when palpating the damaged area. The diagnostic guideline is the deviation from the horizontal level of the line of the conventional Huter triangle, formed by the lines between the olecranon and the condyles.

Diagnostics

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

When there is a need for more detailed study trauma, examination of the capsule, ligaments, vessels and nerves, prescribe computer or magnetic-resonance tomography(CT, MRI).

Features of fractures in children

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

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

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

First aid

When providing first aid, it is very important to fix your hand so as not to cause additional injury to the victim.

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

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

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

For fixation, you can use a special Kramer ladder splint, bending it along the hand, or available material - a board, plank, it is placed along outer surface shoulder You need to put a soft cushion under your armpit and bandage your arm to your body. You can also do fixation with 2 gussets: tie one hand to the body, hang the forearm to the neck on the other. Together with the elbow, the shoulder and wrist joints need to be immobilized.

Treatment

Treatment tactics depend on the nature of the fracture, the degree of its displacement, the presence of complications; it can be conservative or surgical.

Conservative therapy

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

Reduction and fixation

When closed reduction of fragments and reliable fixation of the fracture is possible, in which it can heal normally, after reduction a plaster splint or circular bandage is applied.

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

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

The quality of plaster application is very important. An unprofessionally applied bandage can compress the arm, causing poor circulation and swelling of the hand. As a result of compression, neuritis of the ulnar and radial nerves may develop. Weak application of the bandage leads to its failure and secondary displacement of fragments. Skin damage is also possible if the bandage is too hard and does not have a cotton pad. Compression and disruption of the blood circulation of the skin occurs, areas of irritation and detachment of the upper layer appear - epidermal blisters.

Drug treatment

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

Physiotherapy

Physiotherapeutic procedures are indicated a few days after the injury, when the danger of hematoma growth has passed. Assign UHF, magnetic therapy, iontophoresis with calcium using the longitudinal method without removing the plaster cast.

Electrical procedures are not indicated for patients in traction with metal wires.

Exercise therapy

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

A set of exercises for rapid rehabilitation after an elbow fracture

Surgical intervention

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

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

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

Stages of rehabilitation

After removing the cast, it is necessary to begin active development of the joint so that contracture does not develop. Complexes of exercise therapy exercises for developing a joint will vary: at an early stage a small load is given, then it gradually increases to full recovery functions. They can be performed at home, having previously been instructed by a physical therapy specialist.

Rehabilitation therapy includes gymnastics and limb massage, which is done before performing exercises, massage begins from the periphery of the hand - the fingers, moving to the shoulder joint. Exercises physical therapy for the joint it is better to do it by immersing your hand in a bath of warm water, dissolve well there sea salt. The joint needs to be worked out until the range of motion is completely restored.

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

The main condition for successful treatment of a fracture of the elbow joint is a timely visit to a specialist, compliance with all medical recommendations, active development of the joint until complete restoration of function.

An example of massage manipulations for developing the elbow joint

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

Classification

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

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

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

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

No offset

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

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

transverse;
longitudinal;
helical;
oblique;
compression.

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

With offset

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

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

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

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

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

Isolated

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

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

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

First aid

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

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

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

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Treatment

Treatment for a fracture of the ulna can be conservative or surgical. View therapeutic technique depends on the type and severity of the injury.

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

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

at open form fracture;
when conservative treatment has failed;
for complex displaced fractures;
if a segmental fracture is diagnosed.

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

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

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

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

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

Rehabilitation

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

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

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

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

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

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

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

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

Possible consequences

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

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

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

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

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

Prevention of fractures

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

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

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

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

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

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

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

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

Causes of injuries

The elbow joint is extremely vulnerable to damage because there is no dense muscular frame that can provide reliable support and protection to the represented part of the upper limb. This area is especially often exposed to stress in children who are overly active and often find themselves in situations that can cause injury.

An elbow fracture can occur either as a result of a fall or as a result of a significant impact load on this area. Most often, damage to bone tissue here is internal.

Types of fractures

Highlight the following varieties injuries to the bone tissue of the elbow joint:

The elbow joint is characterized by damage to the radius, its neck and head. Most often it occurs as a result of excessive stress when leaning on a straight limb.
elbow joint - in addition to the occurrence of cracks in the bone structure, soft tissues are damaged by fragments. In severe cases, the skin ruptures, a gaping wound is formed, which is accompanied by heavy loss of blood.
A fracture occurs due to significant impact loads on bone tissue. Such injuries are quite rare. Injuries of this type are characterized by consequences in the form of displacement and dislocation of the forearm.

There are also fractures of the elbow joint with and without displacement. Often, with such injuries, one bone is affected.

Symptoms

The following signs may indicate an elbow fracture:

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

A clear sign of serious strong pain at the back of it. Gradually, swelling and hematoma form on the anterior surface of the injured area. Subsequently, the ability to bend the arm is lost. The injured limb hangs limply. When performing movements with the forearm, muscle stiffness is felt.

After a fracture with displacement of the bone, the ability to straighten the arm remains. However, lifting the limb and rotating it to the sides causes significant discomfort.

First aid

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

Conservative treatment

In the absence of injury in open form resort to conservative therapy. During the first 6-7 days after a fracture, swelling usually occurs. Until the pathological manifestation disappears, a splint plaster cast is applied to the arm. Avoid putting weight on the injured limb for up to 3 weeks.

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

Operative therapy

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

The success of surgical therapy directly depends on the accuracy of the trauma surgeon’s actions, in particular the comparison of bone fragments and their correct fixation in an anatomically correct position. The traumatology and orthopedics center is capable of performing such an operation.

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

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

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

Possible complications

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

To prevent complications in children, in particular loss of limb functionality, treatment should be carried out under adult supervision. First of all, the injured arm must be completely at rest throughout the entire course of therapy. The child should not load the limb or perform sudden body movements. Such negligence can lead to a re-fracture.

Rehabilitation

Actions aimed at restoring healthy limb functionality involve:

massage;
therapeutic exercises;
physiotherapeutic procedures.

Development of the joint with the help of physical therapy is possible already on the first day after fixing the limb with a plaster cast. Naturally, in this case, bending the arm at the elbow is avoided. The main emphasis is on finger and wrist movement. The victim is recommended to place the injured limb behind his head while lying down, straining his shoulders. Such solutions help relieve swelling as a result of activating the outflow of lymph from the tissues.

When the joint's ability to flex is restored, it begins to gradually develop. To do this, the main part of the plaster cast is removed, after which measured, gentle movements of the limb are performed. During rehabilitation with the help of therapeutic exercises, it is forbidden to bend and straighten the arm completely, as this can cause a re-fracture.

Massage is resorted to only after the plaster cast has been completely removed. Moreover, the effect is exerted on the muscles of the shoulder girdle and back in a gentle manner. Regular implementation of such procedures allows you to eliminate pain, strengthen atrophied muscles, stretch ligaments and ultimately completely restore hand mobility.

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

Finally

As a result, it is worth noting that the victim needs to clarify several questions for himself after being discharged from the hospital. You should check with your doctor about the best way to move the elbow joint, when you can load the limb with weight, how to avoid relapses and complications, what you can expect in the near future.

The elbow joint is a complex joint that combines the humerus, radius and ulna. These bones form three joints, which give the joint the ability to move in the vertical plane and rotate along the axis of the shoulder. Due to mechanical factors, fractures of various types occur, which differ in location, mechanism of injury, combination of several factors at once, etc. A fracture of the ulna is quite rare.

Causes

The elbow joint is characterized by increased strength and stability due to its special structure, muscle tendons and strong ligaments, but this mechanism cannot protect the joint and adjacent bones from injury.

The causes of traumatic situations are associated with unexpected falls or receiving a direct blow. The first is most typical for children and the elderly. Children often fall due to their mobility, and old people have weakened bones, so even a slight loss of balance leads to damage to the integrity of the bone.

Fractures of the joint, head and neck of the radius are typical for athletes and people who lead an active lifestyle. In particular, Monteggia injuries are very complex and take a long time to recover, most often occurring in young men when they fall on their arm or when trying to resist a blow with a bent arm. In addition, some diseases, such as osteoporosis, increase bone fragility and, with it, the risk of injury.

Classification

In accordance with International classification ICD-10 disease, this type of injury has code S52.2.

Types of fractures:

Depending on the location, there are:

fracture of the elbow process;
fracture of the coronoid process of the ulna;
radial head fracture;
radial neck fracture;
fracture of the epicondyle of the shoulder;
fracture of the styloid process of the radius.

Symptoms of injury

The clinical picture includes both general symptoms and typical signs, indicating damage to specific bone structures. TO general symptoms, characteristic of any types of fractures of the elbow bones include:

pain in the arm that spreads to the fingers and chest;
swelling of the tissues surrounding the injury site;
deformation of the limb in the upper, middle or lower third;
limited mobility;
the appearance of hematomas, bruises;
decreased sensitivity, numbness skin, weakness in the hand and forearm.

Treatment of elbow bone injury

a) the mechanism of a “parrying” fracture; b) flexion; c) extensor

Often such an injury is combined with a dislocation or displacement, so it is necessary to seek help from a doctor as soon as possible. It must be said that a fracture of the ulna can be isolated, and there is also a Monteggia injury. In the first case, provided that there is no displacement, surgery is not performed, and treatment consists of wearing a plaster cast. The cast is supported by a scarf bandage. The duration of wearing the plaster is 6–10 weeks, and after its removal the patient is recommended to perform special exercises, go for massage, mechanotherapy.

The following are also shown healing procedures, such as ozokerite, paraffin therapy, thermal baths. In general, the duration of rehabilitation varies from 2 weeks to 1.5 months. In case of a displaced fracture, closed reduction of bone fragments is performed and a plaster cast is applied. In this case, treatment can last up to 1 year. In severe cases, surgery using pins and plates is indicated. The patient is recommended to take antibiotics and analgesics, and the rehabilitation course takes up to 3 months.

Monteggia injury is often associated with dislocation of the radial head. In about a third of cases, a flexion fracture is diagnosed, in which the head of the radius is displaced or broken off. But most often there is an extensor fracture, in which the head of the radial bone is dislocated forward or laterally, damaging the integrity of the annular ligament of the radius.

To make an accurate diagnosis, an x-ray is taken in two projections and the bone is studied in more detail on a CT scan.. MRI allows you to assess the condition of subcutaneous tissues. Conservative method treatment involves performing a one-stage reposition followed by application of a plaster bandage.

Photo of an ulna fracture

However, most often it is carried out surgical treatment, comparing bone fragments and fixing them with plates. Further treatment consists of monitoring the correct reposition, taking analgesics and anti-inflammatory drugs. After 8–12 months, the plates are removed from the ulna. In case of Monteggia injury, it is very important to begin treatment of the injury as early as possible, since this type of fracture is fraught with serious complications. We are talking about displacement of the head of the radial bone, delayed fusion or non-fusion of bone tissue, etc.

Treatment of radial head injury

Fracture of the radial head of the elbow joint accounts for one third of all fractures in the joint and is most often diagnosed in women. The vast majority of such fractures are isolated in nature, but sometimes they go “hand in hand” with a fracture of the coronoid process, rupture of the interosseous membrane, Galeazzi fracture-dislocation, etc.

When treating this injury, the doctor aims to restore the possibility of rotational movement, including the entire range of motion of the forearms and elbows. In addition, prevention of early formation of arthrosis of the elbow joints is carried out.

The degree of displacement, the size of the fragments and the presence of an intra-articular component in fractures of this nature are of great importance. Conservative treatment is indicated only for non-displaced fractures. To do this, apply plaster, use plastic polymer bandage and a rigid orthosis. After 3 weeks, the plaster is removed and it is recommended to begin developing movements in the elbow joint. Surgery indicated in cases where conservative treatment does not produce results or the fracture is open and complex.

Then a decision is made about endoprosthetics, head resection radius, installation of Kirschner wires or the use of external osteosynthesis. As soon as the pain in the fracture area decreases, doctors recommend that the patient begin to move moderately elbow joint. From all of the above, we can conclude that the sooner help is provided to a patient with an injury, the greater his chances of completely restoring the function of the injured arm.