Arm fracture: how long to wear a cast, how long to work out after a displaced fracture of the elbow joint

General information

Bone fractures are usually understood as partial/complete disruption of the integrity of bone tissue, resulting from trauma (fall, direct blow), in which the destruction of bone tissue is caused by mechanical force that exceeds the hardness of the bones. Less commonly, a fracture is the result of a number of diseases, which are characterized by changes in the structure of bone tissue (pathological fracture in osteoporosis ).
At the same time, when a bone is fractured, rupture of the subcutaneous tissue/skin, damage to nerve fibers, blood vessels, tendons may occur, and the fracture site may come into contact with the external environment (open fracture) and fractures without damage to adjacent tissues (closed fracture). When the bone is damaged in two or more places, we are talking about a complex fracture, which is often accompanied by displacement of bone segments; when a bone is damaged without dividing it into segments, they speak of a simple fracture (crack). The severity and type of fracture are determined by the mechanism of injury, the direction of force and power of action on the bone, and the properties of the bone (bone type, strength). A fracture of the arm is one of the most common pathologies, accounting for about 65% of all bone fractures, and among the bones of the arm, the most common are fractures of the forearm (ulna, in particular the ulna/coronoid process of the ulna) and the radius - radial diaphysis bone, styloid process). Fractures of both bones of the forearm are less common.

Another common problem is fractures of the bones of the hand , which are caused by a fall with emphasis on the hand or a blow to the hand. The most common are fractures of the finger (phalanx), less commonly fractures of the metacarpal bones ( Roland / Bennett ) and quite rarely - fractures of the wrist bones (scaphoid, pisiform and lunate). Among the fractures of the phalanges of the fingers, the most common fracture is the nail phalanx, mainly the ring and little fingers. At the same time, with fractures of the diaphysis of the phalanges, the finger is often displaced with an open angle to the rear. Especially often, a displacement of a finger accompanies a fracture of the little finger on the hand. Displaced fractures are less common.

Elbow fractures

A fracture of the elbow joint occurs when a fall/hit to the elbow occurs, less commonly when falling on a straight arm. A special feature of the elbow joint is its complexity. In fact, this is one of the most complex joints, which is formed by three bones: the humerus, radius and ulna, moving in different planes, the articular surfaces of which are small and extremely fragile. Accordingly, even with minor displacements of their surfaces, a change in the volume/structure of the joint occurs, which almost immediately blocks any movements in it; if a fracture occurs with the formation of fragments of bones/cartilage, they immediately fill its cavity, and with an open fracture of the joint, the adjacent nerves are often damaged fibers and vessels. Due to the complex structure of the elbow joint, fractures of various joint structures can occur: fracture of the epicondyles of the humerus; olecranon; coronoid process of the radius; neck/head of the radius, each of which has its own clinical manifestations. In practice, a fracture of the elbow joint in a child is much more common.

Structure and functions of the metacarpal bones of the hand

There are a total of 5 metacarpal bones on each hand. They have a tubular structure.

The bases of the metacarpal bones are cuboidal in shape, connecting through ligaments to the distal row of carpal bones.

The body of the metacarpal bone is slightly curved towards the palmar surface and resembles a rocker. Interosseous muscles are attached to the lateral surfaces of the body, which provide fine motor movements of the hand. In case of a transverse fracture of the metacarpal bone, the displacement is difficult to eliminate and maintain precisely because of these muscles, because they constantly pull the fragments onto themselves. The extensor tendons of the fingers are attached to the dorsal surface. The body of the metacarpal bone passes into the neck and then into the head, on which there is an articular surface for connection with the proximal phalanx of the finger. The weakest point of the metacarpal bone can be called the neck; it is at this level that most fractures occur, due to the anatomy and mechanism of injury.

The first metacarpal is unique in that it is shorter and wider than the others and has more extreme angles with the carpus, opposing the axes of the other bones, which characterizes the primary function of the first digit. The second and third metacarpal bones are most rigidly attached to the bones of the wrist with their base. In contrast, the fourth and fifth are more loosely attached and allow the hand to perform more movements and securely grip objects and tools of various shapes.

Pathogenesis

The pathogenesis of a fracture of the arm bone may be based on various mechanisms. Most often, a fracture occurs under the influence of an external force on the bone: a blow directly to the bone, a load along the length of the bone (when falling on the hand), twisting of the bone, which occurs mainly in various injuries of the upper extremities. In the pathogenesis of bone fractures, significant importance is also given to damage to soft tissues, nerve fibers, vessels of tendons and fascia, which is accompanied by the development of inflammation/edema, blood loss with hemodynamic shifts, and acute pain syndrome.

Much less often, the pathogenetic mechanism of a bone fracture is based on structural and quantitative changes directly in the bone tissue, which negatively affect the strength of the bone. Such changes include structural changes manifested by disturbances in the structure of trabecular microarchitecture, accumulation of microfractures in trabeculae/increase in cortical bone pores, which has a significant impact on bone strength. Another pathogenetic mechanism of bone fracture is a decrease in its mass, which leads to a decrease in mechanical strength.

Symptoms of a forearm fracture in the middle third.

Symptoms of a forearm fracture in the middle third are standard for any fracture - pain, swelling, bruising, bone crepitus, deformity, impaired hand function.

With open injuries, a violation of the integrity of the skin also occurs. With very severe soft tissue damage, the fracture can be complicated by the occurrence of compartment syndrome, in which high interstitial pressure leads to irreversible damage to muscle tissue. In any case, if you have the above symptoms, you should immediately consult a traumatologist.

Classification

The classification of fractures of the arm bones is based on several factors, according to which it is customary to distinguish different types of fractures.

By origin: congenital, caused by abdominal trauma during pregnancy or during childbirth, and acquired, among which are traumatic and pathological fractures.

According to the presence/absence of damage to the integrity of the skin and adjacent tissues: open and closed fracture.

According to the location of the fracture:

Epiphyseal proximal/distal (at the end parts of the bones).
Metaphyseal (localization between the epiphysis and diaphysis).
Diaphyseal (the fracture is localized in the middle of the tubular bone).

According to the complexity of the fracture (position of bone fragments): with displacement and without displacement.

In relation to the longitudinal axis of the bone: transverse, oblique, longitudinal, spiral, splintered, impacted.

Causes

The most common cause of fracture of the arm bones is trauma of various origins (at work, at home, during sports). This is predominantly a fall of a person on an outstretched/abducted arm; much less often, the injury is caused by a strong blow to the arm. Less common are fractures whose pathological process is based on osteoporosis .

Factors that significantly increase the risk of fracture include:

Impaired ossification of the bone matrix/reduced bone density ( osteomalacia / osteoporosis ).
Physical overload.
Weakness of the muscular-ligamentous apparatus of the hand.
Excess weight.
Poor physical fitness.
A history of upper extremity injuries.
Diseases of the joints of the hand (elbow/wrist)
Long-term/uncontrolled use of medications that affect bone metabolism (antidepressants, cytostatics, anticonvulsants, glucocorticoids, etc.).
Overload in athletes due to excessive training.
Genetically determined disorders of the osteogenesis process.
Osteoporosis (mainly in older people, which is caused by metabolic disorders in bone tissue).
Bone tumors/bone cysts .
Tuberculosis of bones /joints.

Causes of fractures

The main reason is a fall on an outstretched arm. This is an innate reflex that a person uses when he loses his balance. When falling, people stretch out their arms to support and protect their internal organs, face, and head. But the protective mechanism does not always work; the radius bone cannot withstand the force of the blow or the weight of the body and breaks.

Trauma can happen to anyone at any age.

Risk group : athletes, people over 50 years of age, patients with diseases of bones and joints.

Symptoms

In the clinical picture of a bone fracture, regardless of its type, it is customary to distinguish absolute and relative signs of a fracture of the arm. Absolute signs of a bone fracture include: pathological mobility, severe pain, especially during physical examination, the presence of deformation of the longitudinal axis of the limb and crepitus of bone fragments at the fracture site. Absolute signs that allow you to determine a bone fracture include pain with pressure, swelling at the fracture site, pain on palpation of the bone, muscle spasm, and change in skin color. These are general signs of a broken bone, but when a specific bone is broken, specific symptoms appear. Due to the large number of bones that form the upper limb and the possibility of fracture of any of them, we will consider below only a few of the most common fractures of the arm.

Radial head fracture

A characteristic symptom is the appearance of sharp pain in the elbow joint, which intensifies when trying to bend/rotate the arm, as well as during palpation. Objectively, hemarthrosis / edema , limited movement, especially when trying to perform a rotational (circular) movement of the forearm, and joint deformity are determined visually. With a combined fracture of the head of the radius and dislocation of the forearm, a more severe deformation is observed, there is practically no movement in the joint, and there are often disturbances in sensitivity and blood supply, which is manifested by numbness of the fingers.

In case of a fracture of the diaphysis of the radial bone, the symptoms are relatively blurred and manifest themselves as swelling in the area of the fracture, pain, which intensifies when attempting to perform rotational movements and palpation of the bone fracture. Typically, there is no bone mobility or crepitus because the radial bone fragments are held in place by the interosseous membrane.

Fracture of the radius in a typical location (photo below)

Characterized by severe pain and swelling, hemorrhages , crepitus and pathological mobility . When bone fragments are displaced, deformation with localization slightly above the wrist joint is visually determined. The pain syndrome increases sharply with palpation and attempts to perform movement. When Galeazzi is damaged, there is pain in the middle-lower third of the forearm, which intensifies when pulled by the fingers, severe swelling, and, less commonly, the formation of subcutaneous hematomas. All types of movements in the wrist joint are practically impossible or extremely limited. This type of fracture is often accompanied by damage to nerves/vessels and the development of compartment syndrome (compression of blood vessels/nerve fibers by edematous soft tissues), which can manifest as loss of sensation in the hand area.

Fracture of the phalanges of the fingers (photo below)

Signs of a finger fracture are typical of the typical manifestations of most fractures - pathological mobility, deformation, swelling, severe pain with axial load, subcutaneous hematoma . It is quite easy to distinguish a fracture from a bruised finger by the absence of such symptoms. In addition, with fractures of the diaphysis of the phalanx of the fingers, as a rule, a displacement of the phalanx with an open angle to the rear is formed.

A relatively rare symptom is shortening of the arm, which appears in cases of fracture of two bones of the forearm (radius/ulna) and the presence of displacement of bone fragments along its length.

Radial fracture with and without displacement

According to the clinical picture, radial bone fractures are divided into 2 types:

With offset. In this case, the broken bone elements are displaced relative to each other. The direction of the displacement may be different. Transverse and longitudinal displacements are most often recorded. As a rule, a transverse or oblique fracture line of the radius can be seen on the radiograph immediately after the fracture. Then, the muscles that are attached to these fragments, when contracting, displace them. Much less common is an impacted fracture, where one broken part penetrates into another part of the bone. A displaced fracture is characterized by a noticeable change in the shape of the hand in the form of a typical deformity.
Without displacement or incomplete. With it, muscle strength is not enough to displace bone fragments. A typical option is a crack in the bone. The main signs are swelling of the injury site and severe pain, deformation and dysfunction of the injured limb.

Important! Even by external examination, it is most often possible to classify the fracture. A more accurate diagnosis is made after radiography.

ORTHOPEDIST-TRAUMOTOLOGIST

Tests and diagnostics

The diagnosis of a “fracture of a particular bone in the arm” is made based on a physical examination of the patient, a history, and the presence of characteristic symptoms. The diagnosis of a bone fracture is based on instrumental examination methods: X-ray examination, which makes it possible to identify the location of the fracture, assess its severity and features (presence of displacement, bone fragments, intra-articular damage). In cases of suspected damage to soft tissues, nerve fibers, blood vessels, an MRI or CT scan is additionally performed. In case of extensive open fractures and wound contamination, a laboratory blood test and bacteriological analysis of the wound contents can be performed.

Complications

Like any disease, a bone injury can be complicated by many pathological conditions if treatment for a clavicle fracture is not started in time. Fortunately, complications from injury are quite rare because patients often seek medical attention immediately. However, possible complications due to poor-quality or untimely medical care cannot be excluded:

Injury to a vascular or nerve formation. A displaced clavicle fracture can cause damage to a large vascular trunk or nerve formation, which leads to the formation of characteristic symptoms. In the case of damage to the nerve fiber, disturbances in the motor or sensory sphere in the injured area are observed as long-term consequences of the damage. The severity of neurological symptoms depends on the nature and extent of nerve damage, however, one should not forget about the likelihood of injury to nerve fibers. Damage to the vessel often leads to serious bleeding, especially if a sharp bone fragment has injured a large major vessel, resulting in serious blood loss.
Damage to the pleura . A life-threatening condition for a person, pneumothorax, is formed when displacement during a clavicle fracture causes damage to the parietal pleura. Air enters the pleural cavity, which is accompanied by a characteristic clinical picture (shortness of breath, lack of air, lag of one of the halves of the chest when breathing). Pneumothorax requires prompt action by medical professionals and immediate treatment.

In most cases, fracture complications can be prevented thanks to competent and proper care for a clavicle fracture.

In children

The variety of hand fractures in a child and their mechanisms is due to the presence of growth zones (wide strips of cartilage) between the metaphysis/epiphysis and the elastic periosteum. Therefore, a child may have both complete fractures and bone fractures, “green stick” type fractures (subperiosteal fractures), when bone fragments do not move and are held by the entire periosteum or are located at an angle relative to one fragment to another. Displaced fractures of the arm bones are less common than in adults. Often it is not the arm bone that breaks, but the growth cartilage, which is located next to the joint. These features contribute to the smoothness of clinical symptoms in a large number of hand injuries, which complicates diagnosis.

Treatment in adults

Immobilization of the limb is carried out for 1 month, using a Chizhin frame or other bandages. If displacement of the fragments occurs, then reposition is required (returning the fragments to their normal physiological position) with local anesthesia. Then fixation occurs with a soft or plaster cast.

The reposition is followed by a recovery period, and after some time a control photograph is taken. It is actively used during the rehabilitation period of UHF; in the presence of severe pain, the doctor prescribes painkillers. As soon as the need for immobilization disappears, the doctor refers the patient to massage and physical therapy.

Conservative treatment consists of using soft or plaster casts, as well as fixing the limb. This type of therapy is used for uncomplicated fractures in both adults and children. Immobilization is carried out by a traumatologist who actively monitors the restoration of the integrity of the patient’s bone.

The main goal of conservative therapy is to ensure the correct position of the bone and rigid fixation of the clavicle in this position for a certain time. If displacement of the fragments has not occurred, then immobilization of the shoulder girdle is sufficient for high-quality healing to occur. In cases where displacement has occurred due to a clavicle fracture, preliminary reposition is required; at the next stage, immobilization occurs. In traumatology, there are two types of reposition - closed and open techniques.

Closed reduction is non-invasive, that is, the doctor does not perform an open surgical approach. Using non-invasive medical techniques, the traumatologist performs temporary immobilization, and then x-rays are taken. If the bone fragments have been juxtaposed correctly, then temporary immobilization is changed to permanent plaster fixation. In the case where the bone fragments could not be compared as accurately as possible, a repeated closed reduction or open reduction is performed according to the decision of the traumatologist.

Open reduction has a number of strict indications, because during its use open surgical access to the fracture area is performed. Then the doctor compares the bone fragments in the wound and fixes them, which is called intraosseous osteosynthesis and refers to the surgical treatment of a clavicle fracture.

Diet

Diet for fractures

Efficacy: therapeutic effect after a month
Timeframe: 2 months
Cost of food: 1600-1800 rubles per week

Diet for fractures of the arm bones is an obligatory component of complex treatment and is aimed at accelerating the process of bone healing. A feature of the diet for fractures is:

Sufficient content of complete animal protein containing all the necessary amino acids. The amount of protein in the daily diet should be about 100 g and is provided by consuming lean red meat, chicken eggs, poultry, dairy products (hard cheese, cottage cheese), and white/red fish.
Sufficient content of products containing macro/microelements (calcium, zinc, magnesium, phosphorus). The main products containing calcium include fermented milk products, cottage cheese/milk cheeses, sesame seeds, spinach, hazelnuts, and salad. But effective absorption of calcium can only occur against the background of the presence of vitamin D in the diet (mainly in fatty sea fish and its fat). Phosphorus can enter the body with beef liver, meat, egg yolk, fish, beans, buckwheat porridge, walnuts, buckwheat/oatmeal, dairy products; magnesium - with any wholemeal flour products, porridge (buckwheat, wheat, oatmeal), legumes, bananas, almonds; zinc - with bran, pumpkin seeds, yeast, seafood, sprouted grains, mushrooms, potatoes, beef, sesame seeds, peanuts, onions.
No less important is the presence of products containing sufficient amounts of vitamins A , E , B , C , D , which are necessary to accelerate reactions during the healing of fractures. Vitamin D is especially important , which is rich in chicken yolk, fish oil/fatty fish (sprats); vitamin E , contained in various cold-pressed vegetable oils; vitamin C - in fruits/berries; rose hips, sea buckthorn; B vitamins - in garlic, yeast, offal, cereals, sweet peppers, walnuts, hazelnuts, milk. A fracture of the radius heals on average in 27-35 days, and throughout this entire period, as well as for another 1-2 months, you must follow a diet. It is recommended to supplement dietary nutrition with a vitamin-mineral complex. It is also necessary to completely exclude alcohol-containing drinks and tea/coffee from the diet, the consumption of which helps to reduce the absorption of calcium.

Prevention

Preventive measures for hand bone fractures include:

Prevention of injuries (domestic/sports), for which it is necessary to use protective equipment/follow safety precautions during sports, as well as follow rules of behavior that reduce the risk of injury when in potentially dangerous conditions (slippery roads, poor visibility, crossing traffic routes, etc. .).
Improve bone tissue trophism by including a diet of foods containing sufficient amounts of complete protein, microelements/vitamins, and collagen .
If there is a risk of developing pathological fractures, adequate/timely treatment of osteoporosis .

Consequences and complications

The most common complication of a fractured arm bone is malunion. The severity of the consequences depends on the bone/location of the fracture, the degree of its deformation and can manifest itself as:

Formation of a false joint at the fracture site.
Chronic pain syndrome.
Atrophy/weakening of muscle strength when squeezing the hand.
Instability of the radial/wrist joint.
Contractures of the radial joint with impairment of its function.
Deforming arthrosis of the radial/wrist joint.
Post-traumatic osteomyelitis .
Shortening of the forearm.

As a rule, complications are caused by the lack of adequate/timely treatment, ignoring the rehabilitation period, and non-compliance with doctor’s recommendations.

List of sources

Edinak A.N. Main principles and methods of treatment of forearm fractures / A.N. Edinak, V.N. Kostik // Trauma. - 2002. - T.Z, No. 3. - P. 315–318.
Matsukatov F.A., Gerasimov D.V. On factors influencing the timing of fracture consolidation // Bulletin of Traumatology and Orthopedics named after. N.N. Pirogova N 2, 2021. pp. 50-57.
Vorontsov P.M. Treatment of fractures of the distal metaepiphysis of the forearm bones / P.M. Vorontsov // Man and his health: Materials / Russian National Congress. – St. Petersburg, 1997. – P. 80.
Angarskaya, E.G. Features of fractures of the radius in a typical location / E.G. Angarskaya, B.E. Munkozhargalov, Yu.N. Blagoveshchensky // Siberian Medical Journal. - 2008. - No. 3. - P. 33-35.
Ardashev, I.P. Surgical treatment of improperly consolidated fractures of the distal metaphysis of the radius / I.P. Ardashev, V.N. Drobotov, A.V. Ivanov et al. // Modern high technology. - 2009. - No. 12. - P. 19-21.

Smith's fracture

Smith's Fracture is a flexion fracture of the radius. It happens when a person falls with emphasis on the back of the hand, bent towards itself, or when hit with a hand, when the force falls on this part of the bent hand. With this effect, the distal element of the bone is displaced towards the outer surface.

Characteristic features:

damage to the surface of the palm;
displacement of the radial fragment to the palmar side;
simultaneous displacement of the wrist bones;
slight outer bend of the hand.