Symptoms of an olecranon fracture
- Upon examination, swelling of the joint and its deformation are visible.
- When trying to bend the elbow, movement is limited.
- Hemorrhage is visible in the elbow area.
- When palpating the olecranon, the patient feels pain.
- With a displaced fracture, the protruding part becomes sunken.
The pain syndrome forces the patient to keep his arm in a hanging position.
Diagnostics:
The traumatologist prescribes an x-ray to confirm the diagnosis and determine the extent of damage in the joint. X-rays are taken in two projections. The first is the area of the forearm in its upper part, and the second is the place of attachment of the muscles of the humerus. This is done in order to find out whether the annular ligament has ruptured due to a displaced fracture.
Treatment:
Plaster application:
If the fracture is not displaced, then a plaster cast is applied to the injury site. It covers the upper part of the shoulder together with the forearm.
For loose joints, the doctor prescribes movements from the first days, and the damaged area begins to be worked out after 2 weeks. To do this, temporarily remove the bandage and do careful extensions and return to the previous position. The plaster is then put in place.
Treatment occurs in the same way if there is displacement of the fragments, but only slightly. The hand is fixed in the position in which the fragments take their places. Complete restoration of bone tissue requires 3 to 4 weeks.
Surgery
If during a fracture there is a strong displacement of the fragments, then surgical treatment is necessary. It is performed if there is a distance of 2 mm or more between the bone fragments or they are displaced to the side. Surgical intervention is also required for fractures with multiple fragments. After determining the type of injury, the most suitable treatment method is selected, in which it will be possible to begin movement in the injured area as early as possible. To treat a fracture, osteosynthesis is used, that is, the bones are fastened with two knitting needles and titanium wire.
In our clinic we perform various operations for injuries and fractures!
Useful information about fractures of the shoulder and forearm bones
What are the types of shoulder fractures?
There are fractures of the proximal and distal epiphysis, as well as the diaphysis. A fracture of the proximal epiphysis of the humerus occurs when falling on the elbow or on an outstretched arm. There are fractures of the head, anatomical neck (intra-articular), transtubercular fractures, fractures of the surgical neck (extra-articular) and avulsions of the greater tubercle of the humerus.
Symptoms of a shoulder fracture
The shoulder joint is enlarged due to swelling and hemorrhage. Movement is limited or impossible due to pain. Tapping the elbow causes pain in the shoulder joint. At the fracture site, pathological mobility and crepitus are determined. Clinical manifestations are less pronounced with an impacted fracture. A diaphysis fracture is the most common fracture of the humerus and accounts for more than 50% of all shoulder fractures. It occurs either from a direct blow to the shoulder or from a fall on the elbow or a sudden movement (throwing a grenade, etc.). In adults, the fracture of the diaphysis of the humerus is always complete (transverse, oblique, helical, comminuted), in children it is subperiosteal. Fractures are most often observed in the middle third of the shoulder, where the diameter of the bone is narrowest.
Symptoms of a shoulder fracture.
Pain, pathological mobility, severe deformation. On palpation, bone fragments can be clearly felt. The radial nerve is often injured, resulting in impaired skin sensitivity and the inability to straighten the fingers. Deformation of the lower third of the shoulder and elbow joint. The forearm is bent, movements in the elbow joint are sharply painful. In transcondylar fractures, the relationship between the lines connecting the condyles and the olecranon is disrupted (compare with the healthy side).
Fracture of forearm bones.
There are fractures of the proximal epiphysis, diaphysis and distal epiphysis. A fracture of the proximal epiphysis is divided into a fracture of the ulnar and coronoid processes of the ulna and a fracture of the head and neck of the radius. These fractures occur mainly when falling on the elbow (blow to the elbow) or an outstretched arm.
Symptoms of a fracture of the forearm bones.
Pain and swelling at the fracture site, impaired limb function. When the olecranon is fractured, the arm is in a semi-bent position (the arm hangs down), the victim supports it with his healthy arm. When the coronoid process is fractured, swelling in the elbow area and pain on palpation is determined. When the head or neck of the radius is fractured, there is sharp pain in the area of the outer elbow and impaired rotational movements of the forearm. Sometimes a bone crunch is felt. The forearm is in a pronated position and bent at the elbow joint.
Fractures of the diaphysis of the forearm bones.
They arise from a direct blow. Fractures of both one and two bones are observed at the same (more often) or at different levels. Sometimes fractures are accompanied by dislocation of the radius. In children, fractures of the forearm diaphysis are usually subperiosteal (“green stick”).
Symptoms of a fracture of the diaphysis of the bones of the forearm.
Pain with axial and frontal load, swelling (when fragments are displaced - deformation), pathological mobility.
Fracture of the distal epiphysis of the forearm bones.
The most common fracture of the forearm bones. It is also called a fracture of the forearm (radius bone) in a typical location. Occurs when a fall lands on an extended (extensor fracture) or bent (flexion fracture) hand. Often accompanied by a separation of the styloid process of the ulna, which leads to the formation of a bayonet-like deformity.
Symptoms of a fracture of the distal epiphysis of the forearm bones.
The presence of a bayonet-like deformity and convexity on the palmar surface, swelling, local pain on palpation and axial load, a sharp limitation of movement in the wrist joint indicates a fracture of the forearm bones at the distal end.
Osteophytes of the elbow joint
The formation of osteophytes can be caused by degenerative changes in the joint associated with injury, fractures or overload during professional and sports activities (pitchers, javelin throwers, tennis players, bowlers).
The main symptoms are pain and limitation of movement. Repetitive blockages and joint effusions can also be identified.
Diagnostics
The range of motion in the joint is compared with that on the opposite side. There is usually limited flexion or extension with full or nearly full pronation or supination. In thin patients, large osteophytes can sometimes be palpated.
Differential diagnosis should be made with various conditions leading to limited range of motion in the elbow joint .
Radiography
Obvious osteophytes should always be differentiated from projectional superimposed structures. As a rule, to identify osteophytes in the olecranon fossa, with the exception of advanced cases when the entire fossa is filled with osteophytes.
MRI
MRI plays a supporting role in the diagnosis of osteophytes, especially in the olecranon fossa. Overall, this study provides little new information, especially in cases that are not in doubt.
Arthroscopic findings
Typical areas of localization of osteophytes of various sizes are:
- Coronoid process
- Radial side of the anterior surface of the humerus
- Olecranon fossa
- Apex of the olecranon
With concomitant synovitis, partial synovectomy is required to determine the true size of the osteophytes.
Functional tests under arthroscopic control make it possible to determine whether osteophytes are the true cause of limitation of movements in the elbow joint. At maximum flexion in the joint, the presence of bone impingement in the anterior part of the joint associated with osteophytes is checked; at maximum extension, in the olecranon fossa.
Treatment
The method of choice for isolated osteophytes is their arthroscopic removal . The presence of osteophytes in the anterior and posterior sections indicates severe wear of the joint. After resection, osteophytes often recur, especially if the patient returns to an increased level of physical activity. Before surgery, it is necessary to inform the patient about the possibility of recurrence of osteophytes.
With isolated osteophytes, the prognosis is relatively favorable. Repeated trauma to the olecranon fossa during throwing sports (javelin, handball), as well as sports associated with forced extension and hyperextension (bowling, tennis), predisposes to the formation of osteophytes.
Since osteophytes are formed due to contact between the olecranon process and its fossa, these changes are called “kissing”. Most of these osteophytes occur in the olecranon fossa region.
The main goal of treatment for isolated osteophytes of the elbow joint is to increase range of motion. With multiple osteophytes, the main goal is different, namely, improving the condition of the joint (reducing pain and irritation) before subsequently increasing the range of motion.
Operation technique
Regardless of the location of osteophytes, a general technique for their removal is used.
- Sizing . Usually, the true size of the osteophyte is determined only after partial synovectomy and subsequent study of the range of motion in the joint.
- Partial separation of the osteophyte . Using a thin chisel, the osteophyte is partially separated. Sometimes, in order to completely separate the osteophyte, you have to cut out its base widely. Another method is to remove the osteophyte with a shaver.
- Removal of osteophyte . The partially separated osteophyte is grasped, avulsed and removed under arthroscopic control using a clamp.
- Smoothing the resection area . The resection area is processed with a milling cutter or thin rasp. The use of a ball electrode provides both surface smoothing and hemostasis.
- Functional test . To identify remaining impingement in the resection area, maximum flexion and extension of the joint is performed. Osteophytes on the opposite articular surface are also excluded or removed.
Removal of osteophytes of the coronoid process
The arthroscope is placed in the anterolateral port and maximum joint flexion is performed to identify osteophyte impingement in the coronoid fossa. For bone impingement, partial resection of the coronoid process is performed.
This requires precise placement of the anteromedial port. If it is placed too far posteriorly, that is, close to the anterior surface of the humerus, the coronoid process cannot be reached with straight instruments. Due to the above, this port must be installed especially carefully.
Removal of osteophytes of the coronoid process fossa
In some cases, osteophytes grow so large in the coronoid fossa that they close the coronoid process during flexion. In this case, impingement may persist even after resection of osteophytes of the coronoid process.
Removal of osteophytes of the apex of the olecranon process
The osteophyte is examined through the high posterolateral port. A suitable instrument for resection is a thin chisel.
Removal of osteophytes from the olecranon fossa
Osteophytes are viewed from the high posterolateral port; the posterocentral port is used as an instrumental one. After assessing impingement, the base of large osteophytes is outlined with a chisel or osteotome, creating a fracture zone for subsequent removal. Osteophytes of smaller diameter are partially separated and removed.
Postoperative management
After removal of osteophytes, non-aggressive development of movements is carried out that do not exceed the pain threshold. Stretching exercises and passive mobilization are helpful.
Painful exercises and manipulations can lead to a capsule pain response (capsular fibrosis) and joint stiffness or even reflex sympathetic dystrophy. Non-aggressive rehabilitation is especially important after removal of multiple osteophytes, since increasing range of motion is not the primary goal in these patients.