How to provide first aid for a fractured forearm bones

Last Updated on 07/05/2017 by Perelomanet

Unfortunately, there are sad statistics of fractures, where, along with various injuries to the extremities, a considerable number of forearm injuries are presented. In cases of their occurrence, it is important to provide first aid for fractures, on which further recovery, and sometimes the quality of life of the patient in the future, largely depends. Forearm injuries are most often associated with young children, the elderly and athletes who are at risk due to the possibility of receiving a direct blow or as a result of falling on their arm. Fractures are classified as closed or open, with or without displacement.

Symptoms

The human hand is conventionally divided into four sections. From below - the hand, then the wrist, forearm and shoulder. The forearm is bounded above by the elbow joint, and below by several wrist joints. The complex structure of the forearm allows a person to perform some important movements and actions with the limb. Fractures of the radius and ulna, which make up the forearm, encountered in medical practice are classified according to their severity. But regardless of this, the method of providing emergency care is the same. First aid for a forearm fracture consists of several stages, which are performed in the presence of pronounced signs of injury:

with a closed fracture, the integrity of the soft tissues is not damaged, whereas with an open fracture, there are lacerations;
displaced fractures suggest a visually noticeable deformity of the limb;
sharp piercing pain;
hematomas;
swelling;
a specific sound (click) heard during movement;
complete or partial immobilization of a limb.

An open fracture requires immediate treatment of the wound with alcohol or iodine. The patient needs immediate medical care, which can only be provided in a hospital setting. You can deliver the patient there from the scene of the accident yourself or with the help of ambulance doctors.

First aid for fractures of the shoulder, forearm and hand

Injuries to the upper extremity rank first among all other injuries in frequency. Fractures of the humerus are divided into fractures of the proximal and distal ends, as well as the diaphysis of the humerus. In turn, fractures of the proximal and distal ends of the humerus are divided into intra-articular and extra-articular.

Fractures of the proximal end of the humerus are divided into fractures of the head and anatomical neck (intra-articular) and fractures of the surgical neck (extra-articular).

Fractures of the head and anatomical neck are rare and, as a rule, in elderly people. The mechanism of injury is indirect (falling on the elbow of the abducted arm). The shoulder joint is increased in volume (edema, hemarthrosis), palpation and axial load are painful. Active and passive movements are limited due to pain.

Surgical neck fractures are common, mainly in the elderly. They occur when a fall occurs and a force is applied along the axis of the shoulder, less often when a traumatic force is directly applied. Depending on the mechanism of injury and the position of the peripheral fragment, adduction (adductor) and abduction (abduction) fractures of the surgical neck are distinguished. An adduction fracture occurs when you fall on your arm and bring the shoulder toward the body. Typical displacement of fragments is at an angle, open medially. An abduction fracture occurs when you fall on your abducted arm. Typical displacement of fragments is at an angle, open outward and slightly posterior. When the upper limb is in an average position at the time of the fall, the distal fragment is usually embedded in the proximal one (impacted fracture of the surgical neck). In rare cases, fractures of the surgical neck occur with dislocation of the head of the humerus (fracture dislocation). The fracture occurs in an area that has a spongy structure and is accompanied by extensive hemorrhage. Conditions for healing in impacted fractures, as well as after removal of displacements, are favorable. The clinical picture is characterized by pain, significant swelling and hemorrhage, and dysfunction. On palpation, crepitus of the fragments is sometimes determined. Load along the axis of the limb causes pain in the fracture zone. The type and degree of displacement of fragments is clarified after radiography in two projections. Be sure to determine the peripheral pulse and examine the innervation.

Fractures of the diaphysis of the humerus occur with a direct blow, sudden and strong rotational movements of the peripheral part of the limb. Displacement of fragments at the level of the middle third of the shoulder is not typical and depends on the direction of the force causing the fracture. In this area, the radial nerve, which passes in close proximity to the bone, is most often damaged. In the upper third, supradeltoid and subdeltoid fractures are distinguished. In the first case, the central fragment is displaced posteriorly and inwardly under the influence of the traction of the pectoralis major and latissimus dorsi muscles, and the peripheral fragment is displaced outward, proximally and partially anteriorly by the action of the deltoid, coracobrachialis and triceps muscles. Subdeltoid fractures are characterized by displacement of the proximal fragment outward and proximally as a result of rotation of the deltoid muscle, and the peripheral fragment is displaced proximally and partially posteriorly as a result of contraction of the biceps, triceps and coracobrachialis muscles. Fractures in the lower third are accompanied by displacement of the fragments along the length or at an angle open posteriorly (as a result of traction of the triceps brachii muscle).

Fractures of the lower end of the humerus are divided into supracondylar (extra-articular) and transcondylar (intra-articular). Supracondylar fractures of the humerus include flexion and extension fractures. Transcondylar (T- and V-shaped) fractures of the trochlea and head of the humerus are classified as intra-articular fractures. Most often, these fractures occur as a result of indirect trauma (a fall on an outstretched and abducted arm, on a bent elbow joint).

Extensor supracondylar fractures of the shoulder occur more often in children when they fall on an outstretched arm, with the fracture line directed from bottom to top and from front to back. The distal fragment is displaced posteriorly and outward, and the proximal fragment is displaced anteriorly and inwardly, the olecranon process is displaced posteriorly, and a depression is formed above it. Such displacement of fragments can lead to compression of the neurovascular bundle with the subsequent development of Volkmann’s ischemic contracture. Timely reposition of fragments can prevent such a serious complication.

Flexion supracondylar fractures occur when falling on a bent elbow, with the fracture line directed from top to bottom and from front to back, and the distal fragment is displaced anteriorly.

Transcondylar fractures are intra-articular and occur more often in childhood. Since the fracture line often partially passes through the growth zone, the fracture can be called osteoepiphysiolysis. Due to the fact that the peripheral fragment is displaced posteriorly, the clinical signs of the fracture resemble a supracondylar extension fracture, but with a transcondylar fracture, the isosceles of Huter's triangle, formed by the protruding points of the epicondyles of the humerus and olecranon, is disrupted. Radiography clarifies the clinical diagnosis.

Fractures of the distal end of the humerus are characterized by deformation, swelling and swelling in the area of the elbow joint and the lower third of the shoulder. The patient experiences severe pain when trying to flex or extend the elbow joint, as well as when rotating the forearm. On palpation, crepitus of the fragments is often detected and sharp pain occurs.

First aid for any shoulder fracture involves general pain relief. The patient is administered 1 ml of a 1% solution of morphine hydrochloride or promedol. It is necessary to calm the patient by offering him valerian tincture (20 drops), tazepam or trioxazine (1 tablet), cardiovascular drugs - cordiamine, valocordin or korglykon (20 drops).

Immobilization is performed using a Kramer wire splint as follows:

The arm should be slightly abducted at the shoulder joint and bent at the elbow joint at a right angle. The forearm should be in an average position between supination and pronation, the hand should be slightly bent towards the back, and the fingers should be half-bent, for which a bandage or a thick ball of cotton wool wrapped in gauze is placed in the palm, which the patient covers with his fingers. Fixing the fingers in a straight position is not acceptable. A cotton swab is placed in the armpit and secured with bandages across the shoulder girdle of the healthy arm. It is advisable to place cotton pads around the chest and on the back of the neck.
A long (meter) and wide Kramer splint is bent to the size and contours of the injured arm and applied, starting from the shoulder joint of the healthy arm on the back in the suprascapular region, then on the posterior surface of the shoulder and forearm to the base of the fingers. Two pieces of bandage about a meter long are tied at the corners of the upper end of the wire tire.
Before applying the splint, it is covered with cotton wool or lined with a quilted cotton pad and after application, it is bandaged to the arm and partially to the torso. Attached to the upper end of the splint, two pieces of bandage are passed in front and behind the healthy shoulder joint and tied to the lower end of the splint. Thus, the weight of the forearm tightly presses the upper section of the splint to the back.
The hand is suspended on a scarf or bandaged to the body.

In the absence of special immobilizing materials, improvised materials are used, for example, two planks - one of them is bandaged to the shoulder, the other to the forearm, and both of these segments are tightly fixed to the body. If there are no boots or other suitable materials at hand, the upper limb is placed on a scarf. For the bandage, use a square piece of fabric (preferably cotton) 140-160 cm wide. It is folded in half (diagonally), brought under the bent limb, and the ends are tied around the neck. Flexion is performed at the elbow joint at an angle of 90°. The obtuse angle of the bandage is folded over and secured in front of the elbow with a pin. /1 For more reliable immobilization, the limb together with the scarf is tightly bandaged to the body in a circular motion with the bandage. The victim is transported in a sitting position.

Fractures of the forearm bones occupy one of the first places among all fractures in frequency. They are especially common in children. It is necessary to distinguish between fractures of the diaphysis of the bones of the forearm and fractures of their upper and lower ends.

Fractures of the upper ends of the forearm bones include fractures of the ulnar and coronoid processes of the ulna and fractures of the neck and head of the radius. They arise as a result of direct or indirect trauma (falling on a bent or straightened arm at the elbow joint, falling on the elbow joint).

These fractures are characterized by slight swelling in the elbow and upper third of the forearm, and sharp pain when moving the elbow joint.

For fractures of the olecranon with displacement of fragments between them, the transverse fissure can be palpated.

Diaphyseal fractures of the forearm bones can occur either from direct trauma or from a fall on an outstretched arm. The displacement of fragments is determined by the traumatic force, the level of the fracture and muscle traction. The fragments shift in width, length, angle and periphery. Particular attention is paid to the rotational displacement of radial bone fragments. Thus, when both bones of the forearm are fractured in the upper third, the proximal fragment of the radius, under the influence of the traction of the biceps brachii muscle and the supinator, will be in a position of flexion and supination, while the distal fragment of the radius, under the influence of the traction of the pronator teres and quadratus muscles, will take a pronation position. If a fracture of the bones of the forearm occurs in the middle third, then the proximal fragment of the radius, on which the instep and round ronator will have an antagonistic effect, will take a middle position, and the distal fragments will shift to the pronation position. With a fracture in the lower third, the roximal fragment of the radius is pronated.

The clinic of diaphyseal fractures is characterized by local pain, deformation, swelling, mobility, crepitus of fragments and dysfunction of the forearm. In young children with greenstick fractures, the clinical signs of the fracture are unclear. However, radiography of the bones of the forearm and adjacent joints allows us to clarify the nature of the fracture. A more pronounced clinical picture is observed with a fracture of one of the bones of the forearm in combination with a dislocation in the adjacent joint. A Monteggia injury is a fracture of the ulna at the junction of the upper and middle thirds and dislocation of the head of the radius. Galeazzi's injury is a fracture of the radius at the border of the middle and lower third and dislocation of the head of the ulna.

First aid for fractures of the forearm bones in the upper and middle thirds involves a subcutaneous injection of a solution of promedol or morphine hydrochloride for pain relief and transport immobilization, which is performed as follows:

The arm is fixed in the same position as for shoulder fractures. In this case, the angle of flexion in the elbow joint for fractures of the coronoid process of the ulna and neck of the radius should be acute, and for fractures of the olecranon - 110-120°.
The Kramer tire or mesh tire is bent at an appropriate angle and at the same time given the shape of a trench. Its length should be no less than from the upper third of the shoulder to the fingertips. The tire, as usual, is lined with cotton wool.
The hand is placed in a splint prepared in this way, positioning it along the extensor surface of the injured limb. Then the splint is bandaged.
The hand is suspended on a scarf.

Depending on the type of forearm fracture in the upper and middle thirds and the nature of the displacement of fragments, conservative (closed reposition of fragments, immobilization with a plaster cast or splint), surgical methods and transosseous osteosynthesis are used.

Among fractures of the lower ends of the bones of the forearm, the most common are fractures of the radius in a typical location. They occur when falling on an extended or bent hand. The fracture line runs 2–4 cm proximal to the articular surface and goes obliquely from bottom to top from the palmar surface to the dorsum. The peripheral fragment is displaced to the rear and radially, as well as along the length, at an angle and along the periphery - it is supinated.

This is an extension fracture, or Collis fracture. When falling onto a bent hand, a Smith flexion fracture occurs, with the peripheral fragment shifting to the palmar side and being in a pronated position.

With an extension fracture of the radius, a bayonet-like deformity of the forearm and hand occurs in a typical location. Local pain is noted. The fingers are in a semi-bent position, their movements are limited, especially extension, and movements in the wrist joint are impossible. The patient complains of severe pain at the fracture site. Palpation of the distal forearm causes sharp pain.

First aid for fractures of the radius in a typical location includes the application of a fixing splint from the elbow joint to the fingers, and the use of analgesics. Most patients are treated on an outpatient basis: under anesthesia, fragments are repositioned and immobilized with a plaster splint.

Fractures of the metacarpal bones and phalanges of the fingers most often occur as a result of direct trauma (the hand getting caught in the moving mechanisms of machines, blows from hard objects, etc.). When the metacarpal bone is fractured, a swelling appears on the dorsum of the hand. When several metacarpal bones are fractured, the configuration of the hand changes: its length decreases and its diameter increases. There is sharp pain when palpating the fracture area and when loading along the axis of the corresponding metacarpal bone. The main signs of fractures of the phalanges of the fingers are local pain, which increases with palpation and movement in the joints of the injured finger, its deformation, shortening, thickening and often curvature. In some cases (with cracks, fractures without displacement of fragments), fractures of the phalanges, especially the nail, are difficult to detect.

First aid to the victim

Before the arrival of the medical team, which must be called by the witness of the incident, he can try to provide resuscitation to the victim. These include:

pain relief with strong analgesics, this will help avoid painful shock and calm the patient;
in the presence of open wounds, stop bleeding, apply a tourniquet and disinfection, protect with sterile tissue from possible access to infections;
if possible, urgently apply a special splint or scarf or bandage to fix the limb at rest.

A forearm fracture requires strong fixation in the area of two joints - the wrist and the elbow. The assistance provided must be carried out within the prescribed rules:

the forearm should be parallel to the floor;
the bandage should not be strong so as not to block or disrupt normal blood circulation. This will become noticeable when observing the fingers; they may acquire a bluish tint.

Assistance technique

For an ignorant or inexperienced person with a fracture of the bones of the forearm, it is difficult to figure out how to provide first aid and correctly immobilize the injured person.
It is better to use the services of a doctor who accidentally witnessed the incident or, if he is not there, to use the services of a person familiar with the rules of immobilization. Immobilization involves actions that ensure immobility of the injured part of the body using bandages or splints. It is done as follows:

the victim’s arm is bent at the elbow joint at a right angle;
to prevent the bandage from cutting into the body, a soft thick pad is placed on the shoulder;
a supporting bandage, in the form of a bandage, scarf or hem of clothing, is secured with a pin or a strong clamp. The hand and forearm should be completely inside it. There is no need to use a rope; it will not be able to completely immobilize the injured bone and will add pain when moving.

To secure the hand in one position, they also use cardboard, boards, and thick plastic products that can create a flat surface. If you choose this fixation method, you need to:

place two boards on both sides of the arm, from the elbow to the wrist, and bandage;
place a soft roller in the armpit;
secure the arm to the shoulder using a bandage;
it is important that the ends of the attached board do not coincide with the line of the fracture; for this you need to try to find out from the patient its exact location;
when applying a splint or improvised means, it is necessary to place soft tissue between the skin and the device;
Immobilization for transport should be done so that the arm remains relaxed.

Having witnessed the incident, you are unlikely to be able to determine the exact presence of a fracture in the victim. Not being sure of its existence, perform all the listed activities. They will not harm the victim, but can only provide effective assistance in the future. Before the doctors arrive, it is necessary to monitor the patient’s vital signs - pulse and breathing rate, and also when talking with him, to prevent him from losing consciousness from painful shock, etc.

Diagnostics

An accurate diagnosis can only be made in a medical facility. An initial examination by a traumatologist, X-ray examination, and computed tomography form the basis of the conclusion. The characteristics and severity of the injuries determine the subsequent course of treatment.

In some cases, doctors determine the causes of a fracture in the presence of additional pathologies that cause bone demineralization. This factor increases the risk of fracture even with minor loads on the forearm or other parts of the limb.

Important! Attention to the person’s condition and conversations with him will help to cope with a difficult situation before the doctors arrive.

Possible complications

When a forearm is fractured, in most cases, two bones are broken at once; the contours of their fractures may be at different levels, which contributes to their fragmentation or displacement. If you are not a specialist, you should not try to straighten the victim’s arm, put the fragments back together, or put the bone back in its original place; in this case, it is better to wait for medical help.

In the hospital, medical workers will conduct an x-ray examination, which will determine the degree of complexity of the fracture and methods of its treatment. A frequent additional prescription for the victim is a vitamin supplement containing calcium. And when the bone heals, effective measures are needed to restore painless motor functions of the forearm. Many factors influence the rapid resumption of bone function, such as:

correctly provided first aid;
the severity of the injury, its location;
timely delivery of the patient to the hospital.

Therefore, if you receive this injury, take all possible measures to properly treat the injury.

Types of fractures

The following characteristic injuries to the forearm area are distinguished:

elbow;
radial;
upper ends;
lower ends;
diaphyseal;
fragmented;
mixed (several departments).

The nature of the fracture is influenced by the impact force directed to an outstretched or bent arm, to the elbow or hand. Deformity can be difficult to determine through palpation and clinical analysis. Only radiography helps to clarify the diagnosis.

The complex classification reflects the specifics of the injury, but, in general, does not affect the nature of pre-medical care.