Useful information about fractures of the shoulder and forearm bones

A fracture of the forearm bones is a violation of the anatomical integrity of the radius and (or) ulna bone, resulting from a direct blow or a fall.

Fractures of the bones of the forearm are manifested by sharp pain at the site of injury, swelling, pain on palpation, and crepitus of fragments. When the proximal part of the forearm bones is fractured, movement in the elbow joint is limited, and when the distal part of the forearm bones is fractured, movement is limited in the wrist joint. When both bones of the forearm are fractured in the middle third, visible deformation and shortening of the forearm occurs. Fractures of the distal metaepiphysis of the radius are often called “typical location” fractures. Such fractures are more common in elderly and senile women due to osteoporosis and occur when falling on an outstretched arm.

Causes of fracture of both bones of the forearm

The main risk factors that lead to serious forearm fractures include:

• lack of skills to correctly group when falling;
• making sudden careless movements;
• elderly age of the patient;
• the presence of malignant bone lesions.

Fractures usually occur after direct damaging impact. Common causes of fractures include strong blows to the forearm, road traffic accidents, and falling on the arm.

Medical statistics show that a fracture of both bones occurs less frequently than damage to one of the bones of the forearm.

Fracture symptoms and first signs

When a forearm is fractured, a person experiences sharp and fairly intense pain localized at the site of injury. The injury is often accompanied by a characteristic crunching sound . Almost all types of forearm bone fractures will be characterized by the following symptoms:

• formation of swelling of soft tissues;
• deformation of the injured area, noticeable even visually;
• changes in the skin as a result of hemorrhage;
• the occurrence of strong and sharp pain;
• restriction of the usual mobility of the injured arm.

The following features are characteristic of certain types of fractures:

• with a fracture of the olecranon, there is cyanosis of the elbow joint, swelling and deformation, pain that intensifies when trying to make a movement, there is no ability to straighten the forearm independently, which indicates displacement of the fragments;
• if the coronoid process is fractured, a hematoma in the olecranon fossa will be clearly visible, swelling and pain will be felt in the olecranon fossa upon palpation, and flexion of the injured forearm will be limited;
• with a fracture of the head or neck of the radius, swelling and pain in the area below the elbow joint are sure to occur; the pain may intensify when the injured forearm is rotated outward, its flexion is limited;
• with a diaphyseal fracture, swelling, deformation, intense pain during palpation, axial load, compression of the forearm on the sides, as well as limited mobility are observed;
• with a diaphyseal fracture of the radius, deformation, sharp pain on palpation, mobility of bone fragments, as well as significant limitation of active rotation of the arm are detected;
• with a diaphyseal fracture of both bones, there is almost always displacement of the fragments, a rapprochement of the radius and ulna is observed as a result of contraction of the membrane, deformation and shortening of the injured forearm are clearly expressed, mobility of the fragments is diagnosed, as well as sharp pain during palpation and with axial loads;
• with a Montage fracture (extensor or flexion), shortening of the forearm is diagnosed, when passive flexion is attempted, spring resistance is observed, protrusion is observed on the side of the radius, and retraction is observed on the side of the ulna;
• with a Galeazzi fracture, there is a displacement of parts of the radius of the ulna anteriorly, and the head towards the palm or to the rear, a bulging of the injured forearm is detected from the side of the palm, and from the rear there is a retraction, there is a curvature of the radius, the head of the ulna is reduced when pressed and dislocates spontaneously in the absence of pressure on it;
• with fractures of the radius (extensor or flexion), in a typical place there is a violation of the integrity of the bone just above the wrist joint, cyanosis, swelling, severe pain and deformation above the wrist joint are observed, sometimes the sensitivity of the fourth finger can be impaired.

First aid for fractured forearm bones

The algorithm of actions when a fracture of the forearm bones is detected involves:

• Immobilization (immobilization) of a limb using a splint. You can make a retainer from scrap materials if you have a solid piece of box, a board or stick, a bandage or a long piece of cloth. Help consists of applying a splint to the shoulder, elbow and wrist joints. The splint will immobilize the arm and relieve additional stress from the injured limb;
• Taking painkillers. It is forbidden to take alcohol to relieve pain, since its influence can aggravate the condition of the victim;
• Application of a hemostatic bandage for an open fracture. If a person is bleeding, it should be stopped using a pressure bandage. The wound must be bandaged tightly. If arterial bleeding is observed, a tourniquet is applied to the shoulder.

Symptoms

Symptoms may vary depending on the location of the injury, but the main signs are:

• significant pain;
• visible swelling and deformation;
• cyanosis in the affected area;
• motor functions are constrained and painful;
• presence of hematomas;
• palpation causes increased pain;
• crepitation of fragments;
• deformation, shortening of a limb or forearm;
• sensitivity disorders are possible;
• bleeding;
• traumatic shock.

If you have such symptoms, you should consult a traumatologist.

Treatment methods for forearm fractures

Almost always, when both bones of the forearm are fractured, the fragments are displaced with simultaneous rotation. This often happens at the time of injury and is aggravated by the traction of the forearm muscles. This injury itself is unstable and there is a high risk of re-displacement. If there was a fracture of only one bone, this would be a completely different matter and treatment tactics.

But for complete anatomical restoration and speedy rehabilitation of a fracture of both bones, surgery is necessary - osteosynthesis. Fixation of bones during surgery can be performed using various metal structures: plates and screws, rods, wires, Ilizarov devices, rod devices.

Conservatively (i.e. without surgery), such fractures are difficult to treat. Displacement in length and width in a closed position can be eliminated, but rotation (rotation) of the bone around its axis is almost impossible. In addition, after repositioning (reduction) during the entire period of stay in the cast, secondary displacement may occur due to traction of the forearm muscles.

Artificial bone fixators in the form of plates and rods can be removed 6-18 months after surgery. Restoration of the ability to work of a victim of a fracture of both bones of the forearm can be achieved 1.5-3 months after the operation.

Surgical treatment of the diaphysis of the radius and/or ulna

Fractures without displacement or with slight displacement in this area are quite rare, so most of these fractures require surgical treatment. It consists of fixing fragments (osteosynthesis) . Possible fixation options include installing a plate on the bone or special pins (rods) inside the bone. The method is selected according to indications - depending on the amount of swelling, displacement of fragments and other factors (age, occupation of the patient).

Osteosynthesis of the radius/ulna with a plate

After placing the fragments in the correct position, the metal plate is fixed to the bone using special screws, preventing the fragments from moving. If both the radius and ulna are fractured, two plates are placed. After the operation, a protective plaster splint is applied to the arm for an average of 2-3 weeks. The average length of hospitalization for such surgery is 7 days. After discharge, dressings must be done on an outpatient basis (in a clinic). After 2-3 weeks, the splint is removed and a course of rehabilitation treatment is prescribed - physical therapy, physiotherapy. The plates are removed on average after a year.

Diagnostic methods

The diagnosis is carried out by a traumatologist. It is carried out on the basis of the victim’s complaints, medical history, clinical examination and instrumental examination. If the patient is unconscious, information can be obtained from relatives, witnesses to the incident, and medical workers providing first aid.

To establish a diagnosis, the specialist carries out the following activities:

1. Patient interview. The doctor asks the patient about the symptoms that bother him, finds out when and under what circumstances they appeared.
2. Examination of the limb. During an external examination, clinical signs of an open fracture are identified - a wound with bone fragments located in it, pain on palpation, deformation of the arm, pathological mobility at the level of the fracture, crepitus of bone fragments. The examination is carried out in comparison with a healthy hand.
3. X-ray. Radiography is performed in two projections. This allows you to examine in detail the location of the fracture, the direction of displacement of bone fragments, and assess the severity of the injury.
4. CT scan. A layer-by-layer scan of the affected area is performed. The CT procedure allows you to study fracture lines, see the presence of bone fragments, their position and angles.

Based on clinical and instrumental studies, a final diagnosis is established and treatment is prescribed.

The x-ray clearly shows an open fracture of the ulna with displacement of fragments

What does an open fracture look like?

A bone fracture is an injury that disrupts its integrity. If bone fragments damage soft tissues and skin, an open fracture of the left forearm is observed. Such fractures are considered obviously infected and require special treatment.

Table. Classification of open fractures:

Prevention

Loads on the damaged area should be avoided so as not to interfere with healing and not to provoke re-displacement of the fragments. It is important to come to the doctor for examination in a timely manner and take medications that strengthen bone tissue.

For optimal fusion of bones and rapid restoration of functionality, physiotherapeutic procedures, therapeutic massage and exercise complexes have proven themselves well. You can get information about the best private and public clinics, read reviews about specialists who treat musculoskeletal diseases, and also make a free appointment with a doctor on our website.