Causes and signs of fracture of the elbow joint bones, methods of treatment and rehabilitation. Displaced fracture of the ulna of the arm, treatment time for healing Fracture of the left ulna

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

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

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

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Total information

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

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

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

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

Causes

The described injury occurs:

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

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

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

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

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

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

football;
volleyball;
various types of struggle;
Weightlifting;

and some others.

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

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

In the latter case it is:

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

Development of pathology

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

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

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

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

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

Symptoms comminuted fracture of the ulna

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

When the diaphysis is fractured, the following symptoms appear:

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

The characteristics of pain are as follows:

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

Edema occurs as a reaction of the body to damage.

A hematoma usually appears when a large vessel is damaged.

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

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

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

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

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

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

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

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

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

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

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

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

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

Diagnostics

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

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

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

A physical examination reveals the following:

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

The following methods are used to diagnose a comminuted fracture of the ulna: instrumental research:

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

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

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

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

Differential diagnosis

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

Complications

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

arising directly against the background of a fracture;
distant.

In the first case it is:

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

Long-term complications of this type of injury are:

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

Malunion may manifest as:

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

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

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

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

Treatment comminuted fracture of the ulna, surgery

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

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

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

The patient must be immediately taken to a trauma hospital.

note

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

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

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

Most challenging task is the restoration of congruence of the articular surfaces - this means that they must correspond to one another and slide easily, otherwise the function of the elbow joint will be impaired.

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

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

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

massage;
physiotherapeutic procedures.

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

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

postoperative contractures;
muscle atrophy.

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

Prevention

Measures to prevent a comminuted fracture of the ulna are:

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

Consequences of a comminuted fracture of the ulna

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

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

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

Elbow injuries are considered one of the most serious injuries that require long-term treatment and rehabilitation, like other complex fractures. The fact is that a fracture of the ulna is a bone injury with a complex anatomical structure, so it affects the wrist joint, which is so important for the normal functioning of the hand.

The structure of the ulna is complex, since it is a tubular bone articulated with the radius and forming the forearm. At the very bottom the bone is attached to the hand, and at the top - to humerus. For movement, a person needs the simultaneous participation of three processes of the elbow bone: the coronoid, as well as the ulna and styloid.

If the integrity of the bone tissue is compromised, this will certainly provoke complete immobilization. upper limb, since it is the ulna that forms the elbow joint. When the elbow joint is fractured, the arm becomes immobile. The upper limb can only be mobile if there is a joint, because it is responsible for such important actions and movements as rotation and extension.

A number of reasons that provoke a fracture of the olecranon process are known to medicine today. Practice identifies the most common causes of fracture:

Intentional physical impact carried out with the aim of causing harm to health;
Various types of impacts that occur randomly, the complexity of the fracture here depends on the direction and strength of the impacts;
Osteoporosis is a disease that leads to fractures if excessive stress is constantly applied to the diseased bone;
Falling with an outstretched arm (meaning an attempt to hold on): such a fracture of the elbow occurs as follows, a person extends his arm automatically, but the entire power of the blow is concentrated on the elbow area.

You can avoid injury by following simple rules security.

Classification

The complexity of the bone structure does not distinguish a fracture of the arm in the elbow joint from fractures in other areas, so the classification in this case is standard.

Closed is the most common; when it is received, the skin on the hand does not tear, and the injury itself can be easily identified by swelling, pain and restrictions in movement.
Open differs from closed by violating the integrity of the skin of the hand.
Splintered resembles closed external manifestations, however, it is distinguished by the feeling of fragmentation of bone tissue when palpating the limb. The degree of fragmentation and the number of fragments are determined by x-ray.
A displaced fracture in the elbow joint is easily diagnosed, because the ends of the bone and the bone itself are positioned incorrectly when palpating the damaged area. One part sticks out unnaturally from the elbow.
Fractured bones are an easy option for an injured elbow because healing and full recovery take much less time than a standard injury. A crack implies a breakdown in the structural integrity of the bone.

In medicine, all closed fractures are divided into:

Incomplete;
Full.

In the first case, the bone is not completely broken, but the tubercles are torn off. Metaphyseal fracture is also known to medicine; in practice it is most often called periarticular. The proximity of the injury to the joint area gave it its name. If we are talking about comminuted fractures, then we should distinguish between the concepts of fragment and splinter.

A fracture with a fragment occurs when the bone is separated from the bone canal;
Unstable elbow fracture looks like an uneven line with bends on the picture (when this type of injury occurs, repeated displacement of the bone often occurs).

Consolidating fracture

We are talking about the injury being at the fusion stage. There are four stages of this type of damage:

Primary stable fixation when the doctor compares all fragments avoids the formation callus without disturbing blood circulation;
Fusion secondary nature occurs if the doctor did not compare all the fragments (the likelihood of a callus appearing is especially high in this case);
If the hand is not firmly fixed, the fragments are poorly aligned, fusion does not occur, which means consolidation is impossible;
The fusion of all layers of bone tissue occurs correctly, followed by restoration of the bone and joint of the elbow. The bone hematoma resolves.

Symptoms

Elbow injuries can lead to the following symptoms of an elbow fracture:

Sharp painful sensations at the time of injury;
Sharp pain from touching the damaged area;
Swelling and hematomas in the joint area;
Protrusion of fragments under the skin, visible to the naked eye;
Partial loss of limb functionality;
Movements uncharacteristic for the hand, mobility of a pathological nature;
Accumulation bleeding in the joint, called hemarthrosis.

It is possible to maintain the position of all fragments and prevent inevitable surgery for a displaced elbow fracture through the correct application of plaster. It may be possible to achieve only partial preservation of limb function. All extension and other movements can become extremely painful.

In some cases, the damage can be felt by palpation. If nerve trunks are pinched or damaged, neurological symptoms may appear. Complaints of lack of sensitivity, tingling and numbness of the hand in the damaged area are possible.

When faced with such an injury, first aid must be provided by completely immobilizing the injured upper limb. If you don't have a medical splint nearby, you can make one yourself from materials found at hand. These can be flexible metal rods or planks, or fishing rods.

It is important to bend your arm at a right angle when applying the splint very carefully. The palm should be placed towards the patient's face. It is important to listen to the feelings of the victim.

If he feels a sharp pain when trying to place his arm in the proper position, he will have to give up all bending and clearly fix it in the position adopted after the injury.

The skin should be wrapped in a bandage, a splint should be applied so that it immobilizes all the joints of the hand, and then suspended on a bandage. Antiseptics and sterile bandages should be used for an open fracture, but cotton wool should not be used. The victim can be given pain medication orally.

Diagnostics

An elbow fracture is diagnosed based on the results of examination of the patient. Signs of an elbow fracture alone may not provide enough information, so the diagnosis must be confirmed by an X-ray examination of any kind:

CT scan;
2 x-ray projections.

Usually the doctor gets by with a regular x-ray. Expensive methods are indispensable only in particularly difficult situations.

Treatment

If there is no displacement, the injury can be treated conservatively. With a small displacement, you can do the same. Bone misalignment may require surgery in most cases. It is important that the bone heals correctly, because it depends on further development limbs.

Drug treatment

Drug treatment is used in several variations:

Antibiotics and all kinds of antibacterial drugs;
Anti-inflammatory and painkillers;
Hemostatic drugs;
Antitetanus serum;
Calcium and vitamin complex.

At the end of the last (second) week of active treatment, physiotherapy is prescribed.

Rehabilitation

It is very important to approach rehabilitation competently.

The correct sets of exercises and massages must be repeated until complete recovery. The load is increased very slowly to avoid complications.

Massage

The massage used for an elbow fracture is no different from the massage performed for other types of injuries. Such elements of massage are used as stroking, rubbing, kneading, flexion and extension at the joint, and rotation. It is performed in a sitting position by a specialist.

In this case, an assistant may be present who holds the patient's hand in a suspended position, which is necessary when performing some techniques. Massage helps in the treatment of all joint diseases, provided it is carried out correctly. During recovery, massage is required.

Complications

Complications that occur as a result of a fracture in the elbow are divided into 2 types: early and late. Early complications:

Loss of blood from a broken bone during surgery;
Bleeding caused by damage to blood vessels by part of the bone;
Infection (including tetanus) into the wound during treatment and due to the nature of the fracture;
Pain shock;
Inadequate condition of the structure used to fix the fracture site;
Incorrectly placed sutures as a result of the operation;
Vascular embolism foreign bodies, fat and fabric;
Moving part of the bones under the applied plaster.

Late occurring complications:

Often, late complications arise as a result of incorrectly performed treatment, failure to follow doctor’s instructions and the choice of ineffective recovery methods.

Elbow fracture in children

As a rule, most often elbow fractures in children occur in early age. The reasons are clear - the presence of high physical activity and lack of experience. Often the bone breaks at the place of growth due to the fact that this is its most fragile and at the same time elastic part.

There are difficulties in diagnosing elbow fractures in children under the age of fifteen to sixteen due to the fusion of the olecranon process with the bone. At the same time, general recovery and restoration of joint mobility and function occur much faster than in adults.

Complications in a child do not occur so often. Most often, displacement of parts of the bone occurs due to the desire to move the limb ahead of time. Osteosynthesis is considered the most important treatment method for a child, thanks to which the ability to move the arm appears within a few days after the operation.

Massage of the elbow joint is an 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:

First, First 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;
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..

The development of the arm cannot be carried out until 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 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 at the moment of straightening. With no offset there is a little more freedom of movement.

The most common locations of fractures

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

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

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

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

Symptoms of a fracture

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

The following symptoms are observed with this injury:

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

A fracture of the ulna needs timely and proper treatment. The ulna has 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 problems motor functions. If the therapeutic rehabilitation complex does not help restore functions, then surgical treatment is also used.

Through a longitudinal incision, all fragments are returned to the correct position and fastened. If the process does not fit 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! Development of the limb 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.

Physical therapy is used to treat all types of fractures. After the 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 a medical institution, radiography is performed in two projections. If the injury is intra-articular, a computed tomography scan is also performed. The limb is then fixed using a plaster splint. If no displacement is detected, apply a plaster cast for a month.

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

Conservative treatment

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

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

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

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

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

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 lifted 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 sharply intensifies. 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 can lead to increased displacement and swelling.

To correctly diagnose damage, it is enough to pay attention to characteristic symptoms 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 fabrics after damage to blood vessels, it 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 hand.

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

An olecranon injury is a very common hand injury, especially in childhood. The symptoms are not much different from the main ones - the pain is felt on the inside of the joint, radiating to the shoulder and forearm. Swelling and bruising spread over outside 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.
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 Such injury from others is a limitation in rotational movements.
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, external disturbance hands and the crunch of bone fragments appears only if there is a fracture of the entire elbow joint 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 are either completely impossible without outside help;
unnatural mobility of the elbow joint, the possibility of directions of movement that are uncharacteristic for the elbow in normal condition;
decreased sensitivity of the injured hand, numbness, impaired ability to move the 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, be sure to contact one of X-ray methods research.

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, surgical intervention is not performed.

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 in recovery from an injury to the ulna can be divided into three large groups:

Physiotherapy. The timing of restoration of full mobility depends on exercise therapy classes. injured limb. 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. A distinctive feature of this fracture is severe limitations in 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. Pain symptoms intensify upon 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 of pain. 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.

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

displacement of the head of the radius.

shortening of the forearm on the injured side;

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

sharp local pain;

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

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

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

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

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

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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 of the injury as early as possible.

at posterior dislocation 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

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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, making it possible to establish possible consequences.

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

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

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. Total term treatment is several months.

If the coronoid process is fractured, the joint is immobilized for a period of 3 to 4 weeks. The total treatment time including the 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 X-ray or MRI. 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 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 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 to work-related injuries. In the absence of their correct documentation the victim will not receive financial compensation.

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

The characteristics of the patient’s behavior, appearance, and mental adequacy are noted. 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 are distinguished: reliable signs presence of a fracture:

Crunching of bone fragments or their obvious presence in an 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:

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

At improper treatment fracture there is a high risk of developing 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 in each case individually.

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.

Now there are factory-made splints and orthoses on sale varying degrees fixation. 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:

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.
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 damage to blood vessels. 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, painkillers can be given 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.

Providing first aid is simply necessary. In this case, the tactics of first aid should be selected according to the severity of the injury. However, it is not possible to reliably establish the complexity of the injury, for example, with a closed fracture. However, everyone should know the basics of first aid in order to help themselves or others in time.

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

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

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.

In case of an open fracture, pre-treat the wound with an 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 has a 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 surgically in the first days.

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.

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 soon allow you to 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 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 do physical exercise 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.

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 baths and sea salt. 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 return 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. You can’t give a large load at once, 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 return your limbs to working capacity, you must 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.

Physiotherapy

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:

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

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.

A fracture of the ulna is a violation of the integrity of hard tissues due to mechanical trauma. The cause of such damage is a direct blow or a fall from a height. At-risk groups include athletes involved in contact sports, weightlifting, children and the elderly. Increased bone fragility (osteoporosis) can cause injury.

Types and characteristic symptoms of injury

Ulna - triquetral tubular bone, located in the forearm. Depending on the location of the damage, the following can be distinguished:

Monteggia's fracture. It appears as a result of reflecting a direct blow. Wherein middle part The bone breaks completely and is accompanied by a posterior or anterior fracture.
Damage to the styloid or coronoid olecranon.
Fracture of the neck or lower third of the ulna.
Isolated damage to the diaphysis.
Malgenya's injury.

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

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

Type	Symptoms
Monteggia's injury	According to the mechanism of appearance, it can be extensor or flexion. The pathology is characterized by the following symptoms: sharp pain; spread of swelling to the forearm and elbow joint; loss of sensitivity of the limb, change in local temperature (the hand becomes cold to the touch); limitation of mobility.
Isolated damage	sharp local pain syndrome; development of edema in the injured area; visible deformation of the hand; formation of a bruise (bleeding may occur); impairment or complete lack of mobility.

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

First aid

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

Immobilization of the hand using improvised means.
The splint is applied so that the limb is bent at a right angle. The palm turns towards the person's face. If the victim feels pain during immobilization, then the arm should be fixed in the position in which it found itself after the fracture.
Before applying the splint, it should be wrapped in a bandage or other soft cloth.
If there are no means to immobilize the limb, it can simply be hung on a scarf in a free position.
If the fracture is open, then the edges of the wound are treated with an antiseptic to prevent infection.
Since the injury is accompanied by pain, the victim is allowed to take an analgesic tablet or a non-steroidal anti-inflammatory drug.

Before arriving at the emergency room, you should not try to put the fragments together yourself. At the medical facility, the patient will undergo x-rays in several projections. Additionally, he may be prescribed an MRI or CT scan.

Therapeutic measures

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

Type of treatment	Characteristic
Medication	To avoid infection, complications, and also to eliminate symptoms, the following drugs are used: Analgesics and NSAIDs: Analgin, Ibuprofen, Ketorolac. They are used in the first days after injury. Antibiotics. They are necessary for open fractures. Hemostatic agents: Etamzilat. Tetanus prevention serum. Multivitamin preparations containing calcium and vitamin D.
Surgical	Surgery is required for open or displaced fractures of the wrist joint. For multi-fragmented injuries, osteosynthesis is performed. Holes are made in the bone fragments through which a special wire is pulled. It tightens on the outer surface of the bone. After repositioning, the fragments are firmly fixed, and long-term immobilization is not necessary after the intervention. In this case, the range of motion is restored within 30 days, and the fixation structure is removed after a few months. For particularly complex fractures, a plaster cast is placed on the patient’s arm. The joint is fixed at a right angle. The splint is not removed until the bones have completely fused
Physiotherapeutic	Procedures are prescribed to the patient 14 days after the start of therapy. Magnetic therapy and UHF will be useful. After removing the plaster, the person is prescribed warming up the limb with ozokerite, electrophoresis with, mud therapy, salt baths

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

Rehabilitation measures

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

playing with a ball (to develop the hand);
closing your fingers behind your back (additionally, you can raise your hands up);
exercises with dumbbells whose weight does not exceed 2 kg;
rolling a ball or ball in your fingers.

The intensity of gymnastics depends on the degree of complexity of the fracture and gradually increases. Initially, a set of exercises is selected by a rehabilitation specialist. Additionally, massage will help speed up the healing of the hand: pinching, stroking, shaking the affected area, turning the forearm. Duration rehabilitation period is 3–6 months.

Possible consequences

With improper or untimely treatment, the following complications are possible:

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

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

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

Classification

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

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

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

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

No offset

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

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

transverse;
longitudinal;
helical;
oblique;
compression.

Less common isolated view fracture of the ulna, similar in characteristics to a closed transverse fracture without displacement.

With offset

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

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

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, and sometimes deformation is visible. The mobility of the forearm joint is slightly impaired.

First aid

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

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

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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Subject to compliance with the rules for providing emergency care, further treatment and recovery will go faster.

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 on an outpatient basis. If the displacement is slight, the damaged bone tissue is repositioned before applying a plaster splint. Reduction is a closed comparison of bony lesions of the radius. If osteosynthesis is successful, surgical intervention is not required.

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

with an open fracture;
When conservative treatment did not produce results;
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, then 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 muscle tissue 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 muscle tissue atrophy.

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

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

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

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

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

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

Possible consequences

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

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. To the very dangerous infections refers to tetanus.
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 the connective tissue will heal depends on the correct application of the plaster cast and subsequent treatment.

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

If the fusion occurs incorrectly, the arms may repeat operation. 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 mechanical damage, the following preventive actions must be taken:

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 your doctor will recommend.
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 together faster than in adults. In childhood, bone tissue is not fully formed, so it is more often subject to mechanical damage.

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

If a child receives a fracture in the elbow area, parents should ensure that the child does not show excessive activity during the treatment process. Active movements of the 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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