Fracture in the elbow

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

What therapy is used for damage to this plan? How to treat elbow fractures? What is required for rehabilitation? We will try to answer the submitted questions.

Types of fractures

The following types of elbow bone injuries are distinguished:

  1. A closed fracture of the elbow joint is characterized by damage to the radial bone, its neck and head. Most often occurs as a result of excessive load when focusing on a straight limb.
  2. Open fractures of the elbow joint - in addition to the occurrence of cracks in the structure of the bone, soft tissue is damaged by splinters. In severe cases, there is a rupture of the skin, a gaping wound is formed, which is accompanied by abundant blood loss.
  3. Fracture of the coronoid process occurs due to significant shock loads on the bone tissue. Such injuries are rare. Damage to this plan is characterized by consequences in the form of displacement and dislocation of the forearm.

A fracture of the elbow joint is also identified with and without displacement. Often, with such injuries, one bone suffers.

  1. The presence of sharp sustained pain, which gives to the hand and wrist.
  2. Limited limb mobility or its complete paralysis.
  3. Unhealthy, unusual for a person mobility of the arm in the area of ​​the elbow joint, for example in the lateral direction.
  4. The appearance of edema, the formation of bluish hematoma, subcutaneous bruising.
  5. Neurological symptoms - numbness of the fingers and hands, tingling forearm.
  6. Damage to blood vessels, muscle tissue, skin (open fractures of the elbow joint).

A clear sign of serious damage to the elbow joint is severe pain in the back of it. Gradually, on the front surface of the injured area, puffiness and hematoma are formed. Subsequently, the ability to flex the arm is lost. The injured limb hangs limply. When performing the movement of the forearm there is muscular stiffness.

After fracture with displacement of the bone, the ability to extend the arm is retained. However, lifting the limb and rotating it to the sides cause significant discomfort.

Causes of violations

Elbow fracture most often occurs as a result of falling on a joint or a straight limb. Impacts, dislocations and injuries of the humerus can also cause joint disruption. Congenital weakness of the ligament-tendon apparatus of the elbow is also a factor, under the influence of which the chances of damaging the articulation increase.

Types of damage

The fracture of the olecranon is most rarely diagnosed, although when it falls, this part of the limb assumes the main impact force. There are still fractures:

  • head and neck of the radius,
  • namyschilka humerus,
  • coronoid process of the ulna.

In addition, there is a regional fracture of the ulna with displacement, when the bone fragments change their normal location, and without displacement. In case of damage to the integrity of the skin and the release of bone fragments outside, an open fracture is diagnosed. If the soft structures remain intact, the fracture is considered closed. There are also periarticular, intraarticular fractures of the elbow joint.

Characteristic symptoms

If a child or an adult has an elbow joint damaged and the bone is broken, the signs develop instantly. There is a sharp pain, a hematoma and swelling is formed, due to which the arm does not normally unbend. If there is a displacement of the bones, the victim is unable to move his hand, due to damage to the nerve endings, the limb becomes numb. Intra-articular fracture is characterized by abnormal mobility of the articulation.

Fracture of the olecranon and condyles causes soreness localized in the back of the joint. If the neck of the radial bone is damaged, the syndrome concentrates in front of the articulation. Fracture of the coronoid process is characterized by acute pain in the anterior zone of the joint, while flexion-extension of the limb is limited.

Diagnosis of elbow fracture

If the victim has the characteristic symptoms of an elbow fracture, it is urgent to take the person to the emergency room, where he will be examined by a trauma specialist.

After a visual examination, the patient is given a direction on x-rays, which is performed in 2 projections. If there is a fracture of the elbow joint with a shift, while there are suspicions about the destruction of soft tissues, an additional MRI or CT scan is indicated. Depending on the type and severity of injuries, the doctor selects an individual treatment regimen.

Conservative

If the fragments remain in a normal position, or a fracture has occurred with a displacement of no more than 20-30 mm, conservative treatment is carried out. In this case, the immobilization of the limb is obligatory, therefore the plaster is applied on the elbow joint, the arm is fixed at an angle of 45-50 °. Analgesics are prescribed for the relief of a painful symptom. When the swelling starts to decrease, repeat radiography is performed. If there is no secondary displacement, the gypsum is left for another 3-4 weeks, and then a supporting bandage is used. If there are no complications, a course of therapeutic exercises is prescribed. With all the recommendations of the doctor complete recovery occurs in 6-8 weeks.

Surgical

In the case when a person has been diagnosed with a fragmentation fracture, and an elbow joint has moved, an operative intervention is mandatory. Often, osteosynthesis is performed, in which screws, plates, and needles are used. After the operation, the arm is immobilized with plaster, which must be worn until the bone fuses to the end.

Gymnastics

During the rehabilitation period, it is important to follow all the recommendations of the doctor, otherwise there is a high risk of negative consequences. To normalize the functioning of the joint, a complex of therapeutic exercises is necessarily assigned. While the hand is in a cast, it is recommended to perform isotonic muscle contractions in which the limb remains immobilized. When the joint begins to heal, and the risk of developing complications is over, the exercise therapy complex expands, flexion-flexion exercises are added. Basic workouts look like this:

  • Sitting at the table, place your hand in front of you. Slowly lift and then lower the limb.
  • Hands to get behind the back. A healthy limb gently smack the patient, but make sure that there is no discomfort.

As the condition improves, the load on the joint gradually increases. To achieve the maximum effect of the exercises, it is important to practice regularly, without missing a single lesson. During workouts, there should be no discomfort and pain, but if such symptoms occur, you should inform your doctor. If necessary, he will correct the exercises.

Physiotherapy and massage

While the hand is plastered, massage is prohibited. After the risk of complications has passed, it is recommended to massage the back, arms above and below the elbow. Thanks to manual massage, it will be possible to restore the functionality of the joint, reduce pain, prevent muscle atrophy, strengthen the tendon-ligamentous apparatus. Fracture of the hand is successfully cured with the help of physiotherapeutic procedures that contribute to the normalization of blood circulation and nutrition of the affected areas. Due to this effect, tissues regenerate and regenerate faster. The treatment is carried out using such methods:

  • electrophoresis
  • magnetotherapy,
  • laser heating,
  • UHF
  • mud applications.

Do I need a diet?

In order to recover faster from a fracture, it is important to establish nutrition.

It is recommended to enrich the diet with foods that contain collagen:

  • poultry meat, fish,
  • seafood,
  • sea ​​kale,
  • buckwheat, oatmeal,
  • vegetables and fruits,
  • the eggs.

Effects

Fracture of the right or left elbow is considered a serious disorder that requires adequate therapy and a long rehabilitation course. If you follow all the recommendations of the doctor, complications often do not arise. Otherwise, the following consequences are possible:

  • re-fracture, which mainly occurs due to excessive stress on the joint,
  • post-traumatic contracture formation,
  • thrombosis,
  • infectious complication
  • arthrosis.

Prevention

To avoid fractures of the elbow joint, it is recommended to move carefully and avoid falling on a straight arm or directly on the joint itself. When practicing traumatic sports you need to protect your elbow from shock with orthoses. Adequate recovery will help eliminate repeated injuries and the development of post-traumatic complications, during which it is important to dose the load on the limb, as well as regularly perform therapeutic exercises.

Do you still think that it is impossible to cure the joints?

Judging by the fact that you are reading these lines now - the victory in the fight against cartilage tissue inflammation is not on your side yet.

And you already thought about inpatient treatment? This is understandable, because pain in the joints is a very dangerous simtom that, if not treated promptly, may result in limited mobility. Suspicious crunch, stiffness after a night of rest, the skin around the problem area is stretched, swelling in a sore spot. All these symptoms are familiar to you firsthand.

But perhaps it is more correct to treat not the effect, but the cause? We recommend reading the article on modern methods of treatment of joints. Read the article >>

What is a fracture of the elbow joint

The elbow is a complex joint formed by three bones and surrounding soft tissues, including:

  • humerus that goes from shoulder to elbow,
  • the radius and ulna of the forearm, which extend from the elbow to the wrist,
  • ligaments, muscles and tendons that maintain the stability of the elbow and the coordination of movements.

The elbow joint is a mobile connection of the humerus (shoulder) with the ulnar and radial bones (forearm)

A healthy elbow joint allows you to perform the following movements:

  • flexion
  • extension (straightening),
  • rotation of the forearm, or turning the palm up and down.

The condyle is a spherical bone end, the shape of which corresponds to a depression in another adjacent bone so that a movable joint is formed

Fracture of the elbow is called the violation of the integrity of one or more bones of the elbow joint. Such damage is related to serious injuries, which can later lead to problems with motor function, blood circulation and innervation (nerves controlling the work of the organ) of the injured limb. Fractures in children can negatively affect the growth and development of bone tissue. This is due to the fact that in the children's bones there are many so-called growth zones. Since bone growth continues throughout childhood, if one of these areas is involved in a fracture, it can disrupt its development.

The structure of the elbow joint

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

  • brush
  • forearm - from hand to elbow (elbow joint)
  • shoulder - this is part of the arm from the elbow to the place, which is popularly called shoulder, to the shoulder joint
  • above the shoulder joint (where the clavicle is in front, and the scapula is behind) upper arm.

Thus, the elbow joints the forearm and shoulder. In it, three large bones converge and fasten to each other, through tendons, muscles, ligaments, connective tissue and a special form:

  • one shoulder bone
  • two bones of the forearm - radial and ulnar.

Hold these bones together, forming a movable design of the elbow joint:

  • radial collateral ligament side
  • from the ulnar bone - ulnar collateral ligament
  • muscle side - biceps tendon
  • on the side of the bone of the shoulder, the medial (internal) and lateral (external) of the epicondyle (the epicondyle is thickening of the end of the bone to which the muscles and ligaments are attached)

Note! A fracture of the elbow is said when a fracture of the upper part of the bones of the forearm, radial or ulnar, lower part of the humerus occurs.

Symptoms of a broken arm in the elbow joint

Suspected elbow injury can be due to the following symptoms that occur immediately after a forceful impact on the arm:

  • Sharp painwhich can be given down, along the arm around the forearm, in the hand
  • Inability to freely move the arm, bend and unbend it
  • Swelling of tissues in the area of ​​the elbow, color change hands
  • Neurological symptoms with pain - numbnesstingling tissue
  • Non-physiological mobility of the arm in the elbow (the arm from the elbow moves not only up and down, but also from right to left)
  • Feeling of “irregularity” of the structure of the elbow on palpation in comparison with a healthy hand
  • Crunch, "Grinding" of bone fragments.

For children with such an injury, a crying reaction is characteristic, the arm is lowered along the body. The child is trying to support her healthy hand. You can search for a comfortable body position to reduce pain. The baby is restless, agitated, complains about the hand.

Note! Fracture of the elbow joint is not necessarily associated with loss of mobility of the arm, significant edema, or palpable displacement. In case of any sharp pain in the arm after a fall or blow, one should immobilize the limb and show the injured person to the specialist.

Anesthesia

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

  • Analgin, Baralgin or analogues
  • Ketanov
  • Nise

The use of analgesics may slightly relieve pain. However, in severe cases it is ineffective.

Note! Increasing the dose of analgesics does not increase the analgesic effect, but may have a negative effect on the liver.

Treat with antiseptic should injured skin, if any. With an open fracture should:

Fixation of the limb in a fixed position

At the elbow fracture, the arm is fixed in a kerchief and suspended from the neck. The principle is as follows:

  • arm to elbow should be parallel to the floor (bent at a right angle) and turned with a palm to the body
  • arm in bandage should be completely relaxed and lay in it "like in a cradle".

Under a bent arm should be put folded in several layers of cloth (this may be the clothing of the victim or helping). It is necessary to fix the limb in such a position with the help of a wide (full-length shoulder and hand) bandage.

What not to do:

  • you can not straighten a limb along the body
  • do not attempt to cause injury
  • it is impossible to fix the damaged limb with a thin cord - this will not provide the necessary immobility.

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

Treatment for fracture without displacement

If a fracture in the elbow joint occurred without displacement of the bones, the therapeutic measures consist in fixing the limb in a fixed position until the damaged bones coalesce naturally. On hand impose langet. The time it is worn depends on which bone is damaged.

  • Fracture of a neck of a radial bone grows together in 2-3 weeks
  • Fracture of the coronoid process requires immobility for 3-4 weeks
  • Any fracture with an offset is fixed for 4-6 weeks.

Operative therapy

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

With the usual damage to the structure of the end of the ulna, therapy is aimed at tightening the tissues of the medical wire loop. Sometimes an additional fixation of the bones in a static position with the spokes is required.

If you have to treat internal fractures of the elbow joint with the formation of fragments, therapy is based on bone grafting. In such situations, it is difficult to loop the tissues, as this can lead to shortening of the articular surfaces. Instead, resort to the use of dynamic compression plates.

In cases where there are signs of bone fracture, the center of traumatology and orthopedics may offer the patient the replacement of bodily tissue with a special prosthesis. Produce plastic and metal implants. Their installation takes place with the use of bone cement.

Possible complications

In order to prevent the occurrence of complications in children, in particular the loss of functionality of the limb, treatment should be carried out under the supervision of adults. First of all, the injured hand must be completely at rest throughout the course of therapy. The child should not burden a limb, perform sudden gestures. Allowing such negligence can lead to a recurring fracture.

Rehabilitation

  • massage,
  • therapeutic exercises
  • physiotherapeutic procedures.

Development of the joint with the help of physiotherapy exercises is possible on the first day after fixing the limb with a plaster cast. Naturally, in this case, avoid bending the arms at the elbow. The main emphasis is on the movement of the fingers and wrist. The victim is recommended in the prone position to wind up the injured limb behind the head, straining the muscles of the forearm and shoulders. Such solutions contribute to the removal of swelling as a result of the activation of lymph drainage from the tissues.

When restoring the ability of the joint to bend, it proceeds to its gradual development. To do this, the main part of the plaster cast is removed, and then measured, unsharp movements are performed with the limb. During rehabilitation with the help of therapeutic gymnastics, it is forbidden to bend and unbend the arm completely, as this may cause a repeated fracture.

To resort to massage only after the complete removal of the plaster cast. Moreover, the impact on the muscles of the shoulder girdle and back in a sparing mode. Regular execution of such procedures allows you to eliminate pain, strengthen the atrophied muscles, stretch the ligaments and ultimately fully restore the mobility of the arm.

As for physiotherapeutic procedures, they are recommended to alternate with therapeutic exercises. Here resorted to methods of UHF, magnetic therapy, electrophoresis, treatment of curative mud.

Finally

As a result, it is worth noting that the victim, after discharge from the hospital, needs to clarify several questions for himself. It should be clarified with the attending physician how it is better to make movements in the elbow joint, when it is possible to load a limb with a weight, how to avoid relapses and complications, what can be expected in the near future.

Fracture treatment with displacement

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

When the bone is crushed (an injury characteristic of elderly patients), prosthetics and replacement of the joint or its parts are done. A graft (part of the victim’s or donor’s bone), an implant (artificial “part”) is implanted. After the operation, the arm is fixed for accretion as well as for a “simple” fracture.

Note! In children, due to faster exchange and regeneration processes, the terms of accretion of damaged bones are reduced.

In the treatment of childhood fractures, instead of plaster immobilization, the method of operative osteosynthesis is used. Its essence lies in the connection of fragments of parts of the bone with special clamps - knitting needles, bolts, pins. This allows you to maintain the mobility of the joint itself (which is extremely important for children) and reduces the possibility of complications.

Drug treatment of elbow fracture

Drug treatment is carried out in several directions. It:

  • Anesthesia. It is held as needed. Non-narcotic analgesics may be used on an outpatient basis. Narcotic - exclusively in the hospital
  • Nonsteroidal anti-inflammatory drugs prescribed to relieve swelling and reduce pain
  • Antibiotics used in 90% of cases with displaced injuries. Always with open fractures
  • In case of an open injury tetanus therapy.

First stage

Begins 3-4 days after casting or splints. The purpose of the first stage is to support the maximum level of blood circulation in the injured limb, the removal of edema. The patient is prescribed:

  • move your fingers
  • change the position of the arm by cycling the shoulder joint
  • straining the forearm muscles whenever possible with a fixed position.

After removing the plaster, gently begin to move the arm, bending and unbending it at the elbow. The amplitude of the exercise is limited to the sensation of pain.

Note! During the entire period of rehabilitation it is forbidden to lift weights with the injured hand, to hold the position of the body (for example, to hold the handrail in a moving vehicle), to lean on the hand. All exercises are done without burdening.

Second phase

The goal of the second stage is development of injured joint functions. The amplitude of bending to a right angle.

  • Sitting at a high table, so that the tabletop is at the height of the armpit, bend and unbend the hand on the table
  • Standing, hold the light ball on outstretched arms
  • Standing, arms extended forward. Hands up with the ball behind the head and the reverse movement
  • Standing, hands in front of you. Squeeze the ball with both hands
  • Standing, hands in the castle above his head. Bend and unbend both hands, planting a “lock” behind the head.

Gymnastics should take about 15 minutes. It is necessary to do several times a day, if the joint allows (before the onset of pain or severe fatigue).

Third stage

The purpose of the third stage of rehabilitation exercises - full restoration of joint and arm muscle functions. The amplitude is the maximum possible. Muscle strength of the hand no more than 20% lags behind healthy.

At this stage, “connects” therapeutic massage. Massage should be forearm, hand, shoulder, back. The elbow joint itself and the surrounding area cannot be affected.

Note! It is forbidden to perform massage until full restoration of function, until the pain syndrome disappears or to massage the damaged joint.

Physiotherapy procedures are indicated for patients in whom the range of motion is difficult to recover. They can be assigned magnetic therapy, UHF, electrophoresis.

Therapeutic exercises are carried out with a small (up to 2 kg) burden. Choose exercises to flex the extension of the arms from a different position of the body. Gymnastics is carried out with a ball, a gymnastic stick, dumbbells. The load is moderate, to moderate fatigue.

Prohibited:

  • hanging on the bar
  • pushups
  • heavy lifting.

Food and medicine

Nutrition in the post-traumatic period should carry the necessary "building" material to the damaged tissues. The increased load on the body requires:

  • high content of vitamins, trace elements
  • squirrel - for tissue repair
  • calcium - for bone accretion
  • collagen - to regenerate the tissues of the joint and restore its mobility.

The patient menu should be adjusted:

  • The amount of protein consumed should be increased to 2 g per kilogram of body weight. It should be obtained from turkey, chicken, beef, fish, cottage cheese, low-fat cheeses
  • Fresh vegetables and fruits in the daily diet will replenish the necessary supply of trace elements, vitamin C
  • Vitamin E is in the nuts, seeds
  • Calcium is found in dairy products.
  • The source of collagen is the bones from which the broths are prepared, aspic, jellied. Contained collagen in salmon, seafood.

If necessary, the attending physician prescribes pharmaceutical preparations: vitamin-mineral complexes, calcium preparations, Vitamin E and C, amino acids.

Note! If you have extra weight, you should think about dropping it. Overweight people are more clumsy, more injured and less likely to recover. Large weight increases many times the load on the joints, injuring them and contributing to the development of arthritis and arthrosis.

Watch the video: Elbow Surgery. Michael's Story (September 2019).