Fracture of the neck of the radius of the elbow joint

Radial fractures in a typical classic location

Fractures of the radius in a typical location are much more common than all other locations of fractures of the forearm bones. The fracture zone is localized at the transition point of the lower third of the diaphysis of the radius with a more durable cortical layer into the epimetaphysis, mainly consisting of cancellous bone with a thin cortical layer. They occur in all age groups, but most often in older women.

Depending on the mechanism of injury and the type of displacement of fragments, there are 2 types of radial fractures in the classic location (Fig. 42):

Type I (extension, extension, Wheels).

Occurs when falling on a hand that is extended at the wrist joint. In this case, the distal fragment is displaced to the dorsal side. The fracture line has an oblique direction. Often such a fracture is accompanied by a separation of the styloid process of the ulna.

Type II (flexion, flexion, Smith).

It is much less common than type I fractures. Occurs when falling on a hand bent at the wrist joint. The distal fragment is displaced towards the palmar side. The direction of the fracture line is opposite to that of the Wheel. It is not always possible to identify the direction of the fracture plane on an x-ray or determine the mechanism of injury in the patient. In these cases, the leading direction in determining the type of radial fracture is the direction of displacement of the peripheral fragment.

Clinic.

Patients complain of moderate pain at the site of injury, limitation of motor activity of the hand and fingers due to pain. Upon examination, a characteristic bayonet-shaped or fork-shaped deformity with deviation of the hand to the radial side is revealed. Deformation above the wrist joint is caused by displacement of fragments. Palpation of the fracture causes increased pain. Crepitation of fragments is rarely detected. Limitation of active movements in the wrist joint is expressed due to the presence of pain.

In children, greenstick type extensor incomplete subperiosteal fractures often occur in this location. In adolescents and older children, epiphysiolysis of the distal epiphysis of the radius is not uncommon. The mechanism of injury and mechanogenesis of displacement of fragments is the same as in type I or II radial fractures. The diagnosis is made clinically with additional x-ray examination.

Displacement of a peripheral fragment

Offset at an angle, open

Direction of the fracture line (the hand on the X-ray viewer is facing upward)

Rehabilitation

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

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

Clinic and diagnosis of fractures of the distal radius

Patients complain of pain at the site of injury. In the distal part of the radius there is swelling, painful limitation of mobility in the wrist joint and a “fork” or “bayonet” deformity due to displacement of the peripheral fragment to the radial side and to the rear.

Forearm deformity due to Collis fracture

The examination should be painless. It is necessary to check the sensitivity in the area innervated by the median nerve. A displaced distal fragment can lead to irritation of the median nerve with the development of carpal tunnel syndrome. With significant damage, compartment syndrome may develop in the area of ​​the deep flexors of the forearm.

The diagnosis and the nature of the displacement of fragments are clarified by radiographs taken in two projections.

Classification of injury

Depending on the nature of occurrence:

• Pathological - occur not so much under the influence of mechanical force, but as a result of a decrease in bone mineral density. The disease, a clear manifestation of which is pathological fractures, is called osteoporosis;
• Traumatic. They arise as a result of the impact of any mechanical factor on the bone: impact, fall, twisting, excessive physical activity, etc.

Depending on the violation of the integrity of the skin:

• Closed fracture of the radius of the arm, when the skin over the injury site is not damaged;
• Open. In this case, the integrity of the skin is broken, and bone fragments come out.

Depending on the fault line:

• Oblique;
• Transverse;
• Longitudinal;
• Helical;
• T-shaped;
• Impacted, in which bone fragments enter (“impact”) into each other;
• Splintered.

Any type of fracture can be with or without displacement of bone fragments.

There is also an anatomical classification:

• Fracture of the diaphysis (body) of the bone;
• Intra-articular fracture of the head and neck of the radius;
• Fracture of the styloid process.

A fracture of the radius of the arm must be treated

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Treatment

Treatment for a fracture of the ulna can be conservative or surgical. The type of treatment method 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 has failed;
• for complex displaced fractures;
• if a segmental fracture is diagnosed.

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

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

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

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

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

The main symptoms indicating this type of damage

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Anatomical features

The radius and ulna form the human forearm. They are tubular, that is, they consist of a diaphysis (middle part) and epiphyses - two thickenings that are located on the upper and lower sides of the bone. In the center of the diaphysis there is a cavity (medullary canal) filled with yellow bone marrow. The child has red bone marrow in it.

The epiphysis is represented by a thickening, the surfaces of which are in contact with the terminal sections of neighboring bones and form a joint. It consists of spongy substance and has two structures due to which the bone grows in length: the cartilaginous epiphyseal plate and the metaphysis. They are located between the epiphysis and diaphysis of any tubular bone. The pineal gland is one of the storage sites for red bone marrow in adults and children: this substance produces red blood cells and releases them into the bloodstream.

Ulna (ulna)

The anatomy of the radius and ulna is similar. The ulna is located on the outer (lateral) side of the forearm. Its upper epiphysis is an uneven thickening, the structure of which has two processes: posterior (ulnar) and anterior (coronoid). Between them there is a trochlear notch - it connects the bones of the forearm with the trochlea of ​​the humerus. On the coronoid process there is also a round notch intended for the head of the radius. The lower epiphysis is the head of the ulna with a flat articular surface. The head also has a notch for connection with the radius.

Radius (radius)

The upper epiphysis is a rounded head with a depression for articulation with the humerus. And also on it there is an articular surface that connects to the round notch of the ulna. Between the head and the diaphysis there is a neck, and under it there is a tuberosity where the biceps brachii muscle is attached. The lower epiphysis also has a notch for the ulna, and it also participates in the structure of the wrist joint.

REFERENCE! The joints that connect the bones of the forearm move synchronously. And it can also be noted that the elbow and wrist move along with the middle part of the arm. This is possible thanks to a system of joints, muscles, ligaments and tendons that are attached to the interosseous joints.

I have a fracture of the radius bone in my leg. How long does it take for it to heal?

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Complications

With such a fracture, various complications are possible:

• improper fusion of fragments;
• bone fusion of two fragments;
• wound infection;
• damage to blood vessels and nerves;
• stiffness due to frequent inactivity of the limb;
• osteoarthritis and arthritis;
• aching pain in the elbow area.

To avoid complications, it is necessary to follow all the instructions of the attending physician and not skip a single stage of therapy.

It is important to know! Doctors are shocked: “An effective and affordable remedy for joint pain exists. " Read more.

The elbow joint is a complex mechanism consisting not only of bones, but also vessels with nerves, as well as connective tissue. Thanks to joints, it is fashionable to perform many different movements. An elbow fracture is a common type of injury and requires complex therapy, and sometimes surgical intervention.

Elbow dislocation and radial head fracture

Any injury to the musculoskeletal system is always a huge stress for the human body. It's no secret that the younger the body, the faster the healing processes and restoration of lost functions occur. After a period of immobilization, a course of physiotherapy in combination with physical therapy, namely a special set of exercises, is naturally prescribed. In this particular case, given that the period of immobilization (plastering the limb) has been completed and a course of physiotherapy has been completed, but the motor functions of the arm have not been restored, a more detailed examination by a doctor is necessary first. Provided that the bone has healed normally and the tendons and nerve endings are not affected, the doctor will refer you to a specialist in physical therapy. Do not forget that when a limb is immobilized, muscle atrophy occurs and they lose their elasticity. Physical therapy is a combination of physical exercises and breathing, the action of which is aimed at restoring the body after an illness. For injuries of the upper limb, namely the arm, special exercises have been developed, which begin to be performed while the arm is in a cast. Develop joints free from immobilization. After the plaster is removed, exercises are performed for the entire limb. The set of exercises, the number of daily performances, and the complication of the exercises as the arm is restored are determined by a specialist in physical therapy, since excessive load should be avoided in view of the possible recurrence of a dislocation or fracture. Swimming and exercises for the injured arm in water have a very great influence on the restoration of the musculoskeletal system, including in case of fractures of the limbs. As you know, water has a huge therapeutic effect.

In our case, a period of three months is short enough to restore full motor activity, so it is worth seeking help from a specialist in physical therapy.

httpv://www.youtube.com/watch?v=embed/oa3dyPGUvPM

Recovery time

The duration of the recovery period depends on the complexity of the injury and is, on average, 6-8 weeks. The duration of recovery is influenced by factors such as the scale of the operation, the speed of wound healing, the state of the immune system, the presence of bone diseases, etc.

Often, the recovery process after a fracture of the radius is delayed due to the fact that patients neglect doctors’ recommendations, in particular, they independently remove plaster casts ahead of schedule. This is fraught with a number of complications, which will be discussed below.

If your arm swells after removing the cast, this is a normal process. You can find out how to get rid of swelling after a broken arm here.

Anatomy: Ulna and radius.

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:

1. 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.
2. 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 around 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.

If you follow the rules for providing emergency care, further treatment and recovery will go faster.

Causes of fractures

An arm fracture in the elbow joint is a common injury. This is explained by the fact that in this area there is no dense and durable muscle frame. This structural feature of a complex joint is the main cause of frequent injuries.

Causes of a fracture in a child

Fractures in the elbow joint often occur in children. The baby is constantly on the move, busy with active games, so parents do not always have time to prevent extra-articular and other injuries.

Bone tissue in childhood is not yet fully formed, which is why mechanical damage occurs more often in children than in adults.

If you seek medical help in a timely manner, when a child has a broken elbow, healing, even with displaced injuries, occurs faster than in an adult.

Symptoms

You can determine that the elbow has suffered from a fracture by the following symptoms:

• sharp pain radiating to the hand and wrist;
• complete or partial immobility of the affected arm;
• unusual hand mobility;
• swelling;
• hematoma;
• blue discoloration of the skin;
• numbness of fingers;
• tingling in the forearm area.

Usually the affected arm hangs down, and any movement causes severe pain.

Signs of an open fracture

With an open type of elbow fracture, the injured arm hangs down, and any attempt to make a movement causes severe pain. This is one of their main features.

Even “advanced” joint problems can be cured at home! Just remember to apply this once a day.

The temperature may rise, accompanied by a febrile state.