According to statistics, injuries to the elbow joint account for up to 20% of all injuries to the upper limb. In children and the elderly, the incidence of elbow fractures is significantly higher. Due to the high complexity and vulnerability of the elbow joint, any damage to it is considered a serious injury. Often the problem can only be solved through surgery. The success of the intervention depends both on the surgeon’s direct manipulations and on competent rehabilitation. Despite all the achievements of modern science, the outcome of many operations on the elbow joint remains unsatisfactory, and this is due precisely to those aspects that are worth mentioning below.
Features of the structure of the elbow joint
The elbow joint is one of the most complex joints in our body. It is formed by three bones: the radius, ulna and humerus, which move in two planes. The joint cavity is extremely small, and the articular surfaces of the bones connected at the joint are small and fragile. The slightest displacement of the surfaces of the joint, a change in its volume or structure instantly leads to a block and limitation of function.
A feature of the elbow joint is its tendency to fill with cartilage or bone formations in response to even minor trauma. In addition, large vessels and nerves pass in close proximity to the articular capsule. The complexity and fragility of the elbow joint determine the high incidence of complications after injuries and operations and put forward the highest demands on the quality of treatment and rehabilitation.
Indications for operations on the elbow joint
Any operation is a deliberate injury for the benefit of the patient. It carries many risks and pitfalls, so it is prescribed only for strict indications. Most often, patients with such changes in the elbow joint are operated on in the departments of traumatology and orthopedics:
- olecranon fracture,
- condylar fractures, supracondylar fractures of the humerus,
- fracture of the trochlea and head of the humerus,
- radial head fracture,
- dislocation of forearm bones,
- traumatic avulsions of the epicondyles of the humerus and coronoid process of the olecranon,
- ligament and tendon ruptures,
- chondromatosis, osteoarthritis, calcification of the elbow joint,
- rheumatoid or purulent arthritis, etc.
The vast majority of applicants for surgery are patients with fractures. A fall on the elbow during ice, an accident or a fall from a height destroys the delicate tissues of a complex joint and leaves no choice but to quickly collect the displaced bone fragments. Depending on the extent of the damage and the operation after the intervention, hand fixation is prescribed for a certain period of time. As a rule, the limb is immobilized with a plaster cast or suspended from a scarf.
Advantages of elbow osteosynthesis
This is the most common method of radical treatment of fractures and joint injuries in the elbow area. The advantage of this method is that through osteosynthesis it is possible to combine bone fragments that cannot be correctly positioned with conservative tactics due to the development of diastasis between the fragments. With traditional methods, there are difficulties with correct reposition, joint deformations are possible and there is a risk of repeated displacement of the fragments.
The technique has been used for a long time and successfully, has a low risk of complications, helps to return to activity in the coming days after surgery (within reasonable limits) and allows you to do without uncomfortable plaster casts. However, to fully restore the activity of the joint, full rehabilitation is required in compliance with all doctor’s recommendations.
Most common postoperative complications
Even after a brilliantly performed operation on the elbow joint, in many cases severe contracture develops - a sharp limitation in the range of motion in the elbow. In response to trauma, surgical incision and implant placement, adhesions and calcium deposition are activated in the joint. The process of such blockade of movements is aggravated by the appointment of heavy plaster casts. A cast applied even for 2-3 weeks “freezes” the joint in one position.
Not everyone is able to develop movements after removing the bandage. The opposite situation is no less frightening - secondary displacement of fragments after surgery. Insufficient fixation on the gusset under certain circumstances can lead to “looseness” of screws and plates for osteosynthesis. Subsequently, this process is also complicated by severe contracture.
Modern solutions for treatment and prevention
The basis of proper postoperative rehabilitation is a reasonable balance of fixation and mobility. Moderate mobility of the elbow joint after surgery reliably protects against the development of contracture, and sufficient fixation helps the bones, muscles and ligaments grow together. Modern orthoses with adjustable range of motion come to the aid of traumatologists in the early period of rehabilitation. Such splints for the elbow joint have a mechanism for adjusting the degree of fixation from creating complete rest to maximum mobility. Such devices are lighter and more beautiful than plaster; they allow the skin to breathe and make dressings. In addition, only with the help of an adjustable orthosis can the mobility of an already “locked” elbow be improved.
Day after day, increasing the angle of flexion or extension, you can persistently, comfortably and painlessly increase the amplitude and quality of movements in the elbow joint. After recovery, soft or semi-rigid elbow braces may be useful for a more active and early return to active life. Competent consultants at Medtechnika Orthosalon will help you choose the size, shape and type of orthosis that best suits each client.
Author of the article: Eduard Svitich - orthopedic traumatologist
Clinical picture
During a fracture, acute pain occurs. One of the leading symptoms of injury is a crunching sound, reminiscent of the cracking of dry branches being broken. Pain is usually localized on the back of the joint. The following signs are also characteristic of the injury:
- pain radiates to the shoulder and forearm;
- a few minutes after the injury, swelling begins to form, the intensity of which quickly increases;
- the skin in the area of injury is cool, pale, sometimes bluish;
- a hematoma forms a little later. First, pinpoint hemorrhages occur due to ruptured large vessels. Gradually, blood pours into the subcutaneous tissue and an extensive hematoma appears on the front surface of the elbow;
- with an open fracture, the skin is damaged, and bone fragments and sharp edges of tubular bones may protrude from the wound;
- the victim is unable to move the injured arm - bend and straighten the elbow, and rotate the hand.
When injured, the elbow becomes deformed.
Usually the elbow is deformed. Often the pain is so severe that the patient may lose consciousness. Upon palpation, the doctor detects large fragments and assesses the severity of the injury. The symptoms of a crack in the elbow joint are not so pronounced. A large hematoma forms, the area of damage swells, but movement is not limited. The victim holds the injured hand with the healthy one to reduce the intensity of the pain.
Features of fractures in children
In a child, due to the structure of the skeletal system, a fracture of the elbow joint differs from injuries in adults. Until the age of 15-16 years, the bone structure is not yet fully formed; there are so-called ossification zones - weak spots in the bones, where cartilaginous tissue has not yet been completely replaced by bone, especially in the area of the metaepiphysis of the shoulder, the heads of the bones of the forearm. Therefore, bone damage can easily occur not only from a fall, but also from a bruise.
Another feature is the symptoms: manifestations of pain, tissue swelling, the appearance of hematomas, bruises are much more pronounced than in adults and develop faster at the time of injury.
In addition, children are very mobile and often knock out their elbows.
When to start developing a joint?
The period when rehabilitation of the joint begins begins almost immediately after the removal of the plaster. The main thing here is to act without haste, since after an elbow fracture, excessive activity can only damage weakened muscles. As a rule, rehabilitation after an elbow fracture in the form of physical therapy, physiotherapy and water exercises takes from three to eight weeks - the duration depends on the nature of the joint injury. Properly carried out, the course allows you to restore the working function of the elbow joint by 100 percent.
How is the operation of osteosynthesis of the ulna with a plate performed?
During the operation, the patient is positioned on his stomach or back, the limb is placed on the chest area or an additional table. The doctor makes an incision in the area of the back surface of the elbow joint, slightly bypassing the area of the olecranon. The skin is peeled off, the soft tissues are moved apart, the ulnar nerve is isolated and also moved back so as not to damage it.
The doctor identifies all the bone fragments, connects them in the correct anatomical position, fixing them with hooks or forceps. If plates are used for fixation, then the metal structure is attached with screws to the bone fragments. If knitting needles are used, they are passed through two adjacent fragments, and the ends of the protruding knitting needles are tightly fixed with wire loops, which are laid in figure eights and tightened as much as possible to ensure complete compression of the bone fragments. Then the soft tissues are placed in the proper place, the skin is sutured, the wound is drained, and covered with a sterile bandage.
Rehabilitation period
In order for recovery to be as fast and complete as possible, it is necessary to follow a number of doctor’s recommendations after surgery. Immediately after the procedure is completed, the operated patient’s arm is placed on a pillow, moving to the side. No immobilization with plaster is used. Drains can be removed from the wound after two days. After examination by a doctor, the patient is recommended to engage in physical therapy, but without bending the limb at the elbow joint. The doctor controls the movements and shows the necessary exercises. After removing the sutures, for 10-14 days, movements of the entire arm are allowed - active and passive in the joint area. X-ray monitoring is periodically performed to assess the condition of bone tissue. Heavy and forced loads are limited for a period of at least three months.
The clinic performs all types of osteosynthesis in the elbow joint. Experienced traumatologists will help with fresh and even old injuries, developing an individual course of treatment. It is possible to undergo all stages of treatment in the clinic, including rehabilitation. To schedule a consultation and clarify details, you can use the call center phone number or the form on the website.
Contraindications
Before performing an intervention, it is necessary to exclude a number of contraindications to osteosynthesis. Among the key ones are:
- shock or coma, excessive blood loss, disseminated intravascular coagulation syndrome;
- acute infectious or inflammatory processes, fever of unknown origin;
- exacerbation of chronic pathologies;
- problems with blood clotting;
- skin lesions, extensive crush wounds over the fracture zone;
- severe osteoporosis of bones.
The doctor can also determine a number of temporary contraindications, including in relation to the type of anesthesia used.
Causes
A person can break this bone in the following situations:
- falling on an outstretched arm is the most common situation;
- a heavy object falling on the forearm area;
- forearm pinching.
Such fractures are called traumatic and they occur under the influence of a fairly intense damaging force.
If a person's bones become brittle and break even from a small load. This is observed in osteoporosis, calcium deficiency, infectious lesions, and cancer. Fractures in this case will be called pathological.
First aid
When providing first aid, it is very important to fix your hand so as not to cause additional injury to the victim.
You need to carefully examine the joint, in what position the hand is. If it is straight and does not bend, you should not try to bend it. The patient should be placed on his back, the straight arm should be fixed to the body with the help of a bandage, scarf, scarf, and so on. In this condition, he will be transported to the hospital by ambulance.
When flexion at the elbow joint is possible, the bent arm should be applied to the body in a position comfortable for the patient.
The optimal angle of flexion in the joint is 70-100°, but you should not try to bend or straighten, but fix it at an angle where the least pain is felt.
For fixation, you can use a special Kramer ladder splint, bending it along the arm, or improvised material - a board, plank, it is placed along the outer surface of the shoulder. You need to put a soft cushion under your armpit and bandage your arm to your body. You can also perform fixation using 2 scarves: one to tie the arm to the body, and the other to hang the forearm to the neck. Together with the elbow, the shoulder and wrist joints need to be immobilized.
Why should you turn to Scandinavian traumatologists?
The Scandinavia Clinic is equipped with modern tomographs that allow you to accurately diagnose a fracture and choose the most effective treatment tactics.
- Qualification of doctors
. Traumatologists with more than 5 years of experience will make an accurate diagnosis in one visit. - Loyal conditions of admission
. We accept out-of-town and foreign citizens, you can check with the operator for details. - Comfortable hospital
. The hospital is equipped with modern technology, there is Wi-Fi in the clinic. - No queues
thanks to standardized patient registration.