Marginal fracture of the ulna. Symptoms and treatment of a fracture of the ulna of the arm

A fracture of the ulna is a violation of its integrity as a result of external influence. This tubular paired bone of the forearm, triangular in shape, articulates with the radius. At the top they connect with the humerus, at the bottom with the hand. At the top, the ulna continues with a process. Below it ends with a head with a styloid process.

The causes of traumatic bone fractures are most often associated with unexpected falls or direct blows. In children, injuries occur when riding bicycles or rollerblading without special protection or playing sports. In this regard, the ability to fall correctly becomes a necessity. If you fall, you need to free your hands from the load, group yourself and fall on your back, if possible, with an inversion.

Fractures can be open or closed, with or without bone displacement, complicated or uncomplicated. Complications from fractures include bleeding, pain shock, infections, and sepsis. A bone fracture can be:

transverse;
longitudinal;
helical;
oblique;
splintered;
compression.

An isolated fracture occurs rarely and is more often transverse and without displacement, since the radius helps maintain the position of the fractured fragments. Conservative treatment is carried out with the application of plaster.

Compound fractures include elbow injuries. Fractures of the ulnar and coronoid processes of the bone occur quite often. They require surgical treatment and postoperative restoration of motor function.

Damage to the upper third of the ulna, associated with dislocation of the radial head and disruption of the radial nerve branch, is called a Monteggia fracture. It is also called a parrying fracture. It occurs when a person puts his hand under attack.

Definition of a bone fracture

Signs of a forearm fracture are divided into 2 types - probable and reliable. Relative or probable symptoms include:

pain that increases with movement;
the appearance of edema and swelling of the injured area;
limited limb mobility;
hematoma.

If these symptoms are present, an X-ray examination of the damaged area is performed, as a result of which the location and degree of injury to the hand is identified.

For intra-articular fractures, a CT scan (computed tomography) is done. For more complex fractures, magnetic resonance imaging is used.

Absolute or reliable symptoms of a fracture are identified, for example:

unnatural bone mobility in places where there are no joints;
audible crunching of bones;
unusual position of the limb;
visible bone fragments.

An open fracture is complicated by painful shock and blood loss. In this case, much depends on qualified first aid to the patient.

Providing primary care

The severity of the patient's condition will depend on the type and location of the bone fracture. For open fractures, the first step is to stop the bleeding by applying a tourniquet or a pressure bandage. They are applied above the site of the arm injury. The patient's clothes are not removed; if necessary, they are only cut. Open wounds should not be washed with water to avoid additional infection. It should be covered with a sterile or clean dressing.

You cannot change the position of your hand after an injury. It must remain at rest in the same position, for which it is necessary to immobilize it. To fix the hand, use a splint or any object in the form of planks, which is fixed to the hand with a bandage, rope or other available material.

To reduce pain, painkillers are used, for example, 1-2 tablets of aspirin, analgin. The victim also needs to take sedatives (Corvalol, Valocordin) or even a little vodka.

Then the victim must be taken to a medical facility, for which an ambulance should be called.

Treatment for forearm fractures

Treatment of a fracture consists of restoring the anatomical integrity of the bone and motor functions of the hand. The fusion of fragments occurs due to the formation of new tissue, resulting in the formation of a bone callus. The timing of fusion depends on the person’s age; in children this process is much faster.

A fracture of the radius is often accompanied by avulsion of the styloid process of the ulna. In this case, the fragment is repositioned under local anesthesia and a plaster splint is applied.

For isolated forearm fractures with or without slight displacement, conservative treatment is carried out - a deep posterior splint is applied at an angle of 110-120 degrees. It should cover the upper third of the shoulder and go down to the wrist joint. Immobilization is carried out for 3-4 weeks. After the second week, the splint is removed for the duration of physical therapy. Hand movements are performed with the utmost care, after which the splint is again fixed on the hand.

In more complex cases, surgical treatment is performed. Operations are performed under general anesthesia or intraosseous anesthesia.

To reduce pain and restore blood circulation, already during the period of immobilization, physiotherapeutic procedures are carried out using high-frequency electromagnetic fields (UHF) and modeling currents. After removing the plaster, electrophoresis is performed.

The most difficult is a fracture of the elbow joint. This hinge joint allows flexion, extension, rotation and twisting movements of the arm. The complexity of its structure and the rapid occurrence of contractures make treatment of injuries in the elbow joint difficult. In this case, its precise anatomical restoration and strong fixation are extremely necessary. It is almost impossible to achieve this conservatively for displaced fractures, so surgical treatment of patients, including children, is necessary. Even with surgical intervention, it is not always possible to obtain a satisfactory treatment outcome and repeated repositioning may be necessary.

There are several dozen methods of surgical treatment for fractures in the elbow joint, and the choice depends on the specific case. Thus, with a fracture of the coronoid process of the ulna, closed reduction is practically impossible. Therefore, if the displacement of the fragment is small, a splint is applied. If the fragment moves into the joint, it blocks it and must be removed through surgery.

In case of a fracture of the olecranon process, the displacement is eliminated and the fragments are fixed with a metal structure (osteosynthesis). For example, titanium screws and plates are used as internal fixators.

If one bone fragment is broken off, then osteosynthesis of the olecranon process is performed according to Weber. The Weber wire-loop method of treatment is widely practiced as it is simple to perform and generally accessible in design. Titanium wire and needles are used during the operation.

Two titanium Kirschner wires are inserted in parallel through the process into the medullary canal. A hole is drilled into the bone along the fracture plane and a wire is inserted. The knitting needles are tied with wire, and its ends are twisted at the top of the process. The knitting needles are cut short and bent at right angles.

The operated arm is fixed with a scarf. After 3-5 days, the elbow begins to develop with small movements. After a month, the motor functions of the hand are restored, and after 3-4 months, under local anesthesia, the knitting needles and wires are removed from the hand.

An elbow fracture requires a long recovery process. After surgery on the elbow joint for fractures without displacement, it begins within 5-12 days, with displacement - after 2-3 weeks. At the same time, coordination of movement, muscle strength are restored and the range of movements gradually increases. Movements begin with small amplitudes that do not cause pain. There should be no mobility between the broken bones.

In case of fractures of any complexity, the victim must immediately consult a doctor, since timely medical assistance contributes to a faster recovery.

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

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

A little anatomy

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

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

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

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

molecular oxygen;
nutrients and biologically active substances.

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

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

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

Clinical picture

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

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

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

Types of elbow fractures and treatment methods

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

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

Fractures of the lower humerus

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

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

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

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

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

More details

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

Fracture of the proximal ulna

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

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

Treatment of joints Read more >>

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

Fracture of the neck and head of the radius

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

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

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

How to cure a shoulder fracture?

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

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

Signs
Symptoms
Treatment of a shoulder fracture
Rehabilitation. Development of the shoulder joint
Exercises and massage

Signs

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

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

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

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

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

Symptoms

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

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

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

Treatment of a shoulder fracture

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

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

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

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

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

Rehabilitation. Development of the shoulder joint

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

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

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

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

Exercises and massage

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

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

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

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

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

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

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

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

Causes

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

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

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

Classification

In accordance with the International Classification of Disease ICD-10, this type of injury is coded S52.2.

Types of fractures:

Depending on the location, there are:

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

Symptoms of injury

The clinical picture includes both general symptoms and typical signs indicating damage to specific bone structures. Common symptoms characteristic of any type of elbow fracture include:

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

Treatment of elbow bone injury

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

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

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

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

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

Photo of an ulna fracture

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

Treatment of radial head injury

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

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

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

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

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 of bone tissue.

In the latter case it is:

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

Development of pathology

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

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

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

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

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

Symptoms comminuted fracture of the ulna

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

When the diaphysis is fractured, the following symptoms appear:

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

The characteristics of pain are as follows:

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

Edema occurs as a reaction of the body to damage.

A hematoma usually appears when a large vessel is damaged.

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

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

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

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

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

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

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

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

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

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

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

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

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

Diagnostics

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

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

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

A physical examination reveals the following:

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

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

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

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

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

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

Differential diagnosis

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

Complications

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

arising directly against the background of a fracture;
distant.

In the first case it is:

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

Long-term complications of this type of injury are:

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

Malunion may manifest as:

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

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

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

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

Treatment comminuted fracture of the ulna, surgery

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

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

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

The patient must be immediately taken to a trauma hospital.

note

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

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

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

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

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

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

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

massage;
physiotherapeutic procedures.

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

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

postoperative contractures;
muscle atrophy.

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

Prevention

Measures to prevent a comminuted fracture of the ulna are:

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

Consequences of a comminuted fracture of the ulna

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

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

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

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 the 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 of the 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 force 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 safety rules.

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.
Comminuted resembles closed in external manifestations, but differs in 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;
An unstable ulnar fracture looks like an uneven line with bends on the picture (this type of injury often causes the bone to re-displace).

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 allows you to avoid the formation of callus without interfering with blood circulation;
A secondary fusion occurs if the doctor has not compared 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 pain 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;
An accumulation of blood in a 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 the further development of the limb depends on this.

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 by foreign bodies, fat and tissue;
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 at an 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.