Elbow fracture: anatomy, symptoms and types of elbow injuries

Elbow joint

is a unique connection of three bones: humerus, radius and ulna. This is a complex combined joint, which includes three simple joints: humeroulnar, brachioradialis, proximal radioulnar. All of them are united by one common capsule and articular capsule (cavity). Inside the joint capsule, synovial fluid is constantly produced, which serves as a lubricant for the rubbing articular surfaces and nutrition for the anatomical parts. The ends of the bones are covered by a layer of periosteum, which helps protect and renew bone tissue, and also facilitates the supply of nutrients from the synovial fluid. All articular surfaces are covered with articular cartilage. The elbow joint is securely strengthened by ligaments and protected by a good muscular frame. These features allow you to perform four types of movements: extension and flexion, supination (rotation of the forearm in the elbow joint, in which it is possible to turn the hand with the palm up) and pronation (rotation of the forearm in the elbow joint, in which it is possible to turn the hand with the palm down). It is worth noting that the top end of the ulna has an olecranon process, shaped like a hook. The triceps brachii muscle is attached to it. A fracture of this process is a fairly common injury.

Types of damage

The following categories of diseases are characteristic of the elbow joint:

• Traumatic
  Bruises. The most common injuries are to the olecranon, periarticular tissues, humeral condyles and ulnar nerve.
• Ligament sprains
• Dislocations. There are: isolated dislocation and pronation subluxation of the radial head; dislocations of the forearm posteriorly, anteriorly, inwardly, outwardly; divergent dislocations with rupture of the proximal articulation and divergence of the bones of the forearm to the sides
• Fractures of the bones of the elbow joint according to the nature of the damage can be divided into: intra-articular;
• periarticular;
• closed;
• open;
• no offset;
• with displacement of fragments (displacement of bone fragments most often occurs with fractures of the olecranon)

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 treatment 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 of the elbow - 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.

Symptoms of pain

The main symptom of elbow disease is pain.

The following signs are typical for the traumatic group of injuries:

• Piercing pain at the time of injury
• Swelling and hematoma in the elbow joint
• Elbow deformity
• Restrictions in arm movements, partial or complete loss of limb function
• Or pathological mobility and the possibility of movements atypical for the elbow
• Numbness or tingling in the forearm, wrist, or hand
• Creaking or clicking noise when moving your elbow
• Any discoloration of the skin in the area of ​​injury
• Palpable protrusion of bone fragments under the surface of the skin

If any of the above symptoms occur, you should immediately seek help from the traumatology department.

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.

Types of fractures of the elbow joint.

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 avulsion 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;

Fracture of the capitate eminence.

• 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.

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.

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.

Treatment Options

Treatment largely depends on the type and nature of the fracture in the elbow joint. For non-displaced fractures (for example, the olecranon), conservative treatment can be achieved by applying a fixing plaster cast for several weeks. If a joint has been displaced, then the issue of surgical intervention is decided. To do this, reposition the fragments (closed or open). With open comparisons, surgical fixation of fragments is required; this operation is called osteosynthesis. Osteosynthesis is the joining of bone fragments using special fixing agents (bone grafts or metal structures). If the fractures of the articular part of the humerus are fragmented, then it is possible to replace the elbow joint with a prosthesis. To restore the function of the elbow joint in case of deforming arthrosis, as well as in congenital and acquired deformities and contractures of other etiologies, osteotomy is currently performed. Osteotomy is a surgical operation that helps eliminate deformation of the elbow joint or improve the function of the musculoskeletal system through an artificial fracture with further fixation to give a functionally advantageous position. After any surgical intervention, the patient is prescribed rehabilitation measures drawn up by the attending physician individually for each person.

Fracture of the ulna

Treatment of an isolated fracture

In the absence of displacement, treatment on an outpatient basis is possible. If bone fragments are displaced, hospitalization in the trauma department is indicated.

• Conservative treatment
  . For damage without displacement, a regular or polymer cast is applied for 6-10 weeks. If there is displacement, reposition is performed, a control photograph is taken after 10 days, and the plaster is kept for 10-12 weeks.
• Surgical interventions.
  Operations are performed when reposition is unsuccessful and it is impossible to keep the fragments in the correct position. Osteosynthesis of the ulnar diaphysis is performed with a plate or pin. Immobilization also lasts 10-12 weeks.

In the postoperative period, antibiotic therapy is prescribed, UHF, analgesics, antibiotics, exercise therapy and massage are used. The sutures are removed after 8-10 days, then the patient is discharged for outpatient treatment.

Treatment of Monteggia fracture

The patient is hospitalized in a trauma hospital and closed reduction is performed.

• For extensor injuries, transarticular fixation is sometimes performed using a thin pin to prevent re-dislocation.
• For flexion fractures, fixation of the head with a pin is usually not required.

A plaster cast is applied, a control x-ray is taken, the limb is elevated to reduce swelling (the arm is placed on a pillow or suspended from a special stand), and physiotherapeutic procedures are prescribed. The needle is removed after 2-3 weeks. After 4 weeks, the plaster is replaced, changing the position of the limb. Immobilization is stopped after 8-12 weeks.

Surgical treatment is more often required for the extension type of fracture. Osteosynthesis of the ulnar diaphysis with a pin and suture of the annular ligament are performed. If the ligament cannot be sutured, plastic surgery is performed using an autograft cut from the patient's fascia. The beam head is adjusted and fixed with a knitting needle.

For neck fractures, resection of the radial head is performed; in such cases, a suture of the annular ligament is not required. To speed up fusion, auto- or homografts (small plates of cancellous bone) are applied to fragments of the ulna in some cases. The wound is stitched up. After the operation, physiotherapy, massage, and physical therapy are prescribed. Immobilization is carried out for 3 months.

In children, the surgical tactics are the same as in adults, the only difference is that they try to avoid head resection for any type of injury, since this can negatively affect the growth of the radius and the function of the forearm.

First aid

If you have a non-displaced or slightly displaced ulna fracture, it is important to immediately immobilize the injured arm. This is done using a splint made from improvised means (any flat boards, firmly fixed with a bandage, rope, scarf). If you have any painkiller at hand, you must give it to the victim, provided that he is conscious.

With an open fracture, it is extremely important to avoid infection of the wound and stop blood loss. sexe24. For this purpose, the injury site is treated along the edges with alcohol or an antiseptic, and a sterile bandage is applied, and a tight tourniquet is applied above the wound to stop bleeding (it is important to record the time of application of the tourniquet. If you do not loosen it after an hour and a half, in the tissues above due to the lack of nutrition will begin to die off, and the arm will be lost).