Fracture Of The Elbow Joint

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Fracture of the elbow joint

The elbow joint has a complex structure: it is formed by the humerus, ulna and radius, while inside the main, large joint there are three more small ones. Movements in the elbow joint are carried out only in two planes, but they have a rather complex mechanism.

Large vessels and nerves that are responsible for the blood supply and innervation of the forearms and hands pass through this joint. Therefore, a fracture of the elbow joint, accompanied by damage to blood vessels and nerves, often leads to the development of serious complications. Most often, for proper bone fusion, surgery is performed.

At the same time, the elbow joint is the most stable in the human body, which provides tremendous opportunities for compensation in such an injury. Fractures of the elbow joint account for an average of 20% of all intra-articular fractures.

Content:

• Possible causes of the fracture
• Types of elbow fractures
• Elbow fracture symptoms
• Diagnostics and treatment
• Rehabilitation period
• A set of exercises
• Nutrition after fracture

Possible causes of the fracture

The cause of the fracture may be a fall on the elbow or a straightened arm, a direct blow to the olecranon, a previous joint dislocation, or an injury to the forearm. The likelihood of getting a fracture is increased when the elbow ligaments and tendons are weak.

Types of elbow fractures

The olecranon of the ulna is a typical localization of an elbow injury: it is not protected by the muscular frame and always takes the first blow. However, fractures of the olecranon are quite rare, in 0.8-1.5% of cases.

Other types include fractures:

• The head and neck of the radius (occurs when falling with an emphasis on a straight arm);
• Coronary process of the ulna (rarely occurs, but usually combined with dislocation, displacement, forearm injury);
• The epicondyle of the humerus.

Also, fractures are subdivided into intraarticular and periarticular, closed and open, with and without displacement of bones. In 53% of cases, a fracture injures one bone. Closed fractures, which are more common, do not damage soft tissue. With open fractures, the integrity of the skin is violated, an open wound appears and the bone tissue comes out.

Elbow fracture symptoms

• Severe pain in the elbow joint and forearm, which can spread to the wrist joint and fingers;
• Significant limitation of mobility in the joint or complete immobility;
• As an opposite phenomenon - pathological, unusual for the norm, mobility in any one direction, for example, lateral;
• Edema and the formation of severe hematoma due to hemorrhage in the joint cavity;
• Neurological symptoms may appear - tingling and numbness in the forearm, hand and fingers, as damage to nerve fibers occurs;
• Damage to muscles, blood vessels, nerves, skin in the event of an open fracture.

With a fracture of the olecranon, pain occurs in the back of the joint, which can radiate to the forearm and shoulder. Edema and hematoma extend to the anterior surface of the joint. The function of arm extension is impaired, since triceps is attached to the olecranon, which is responsible for the extension of the forearm. The injured arm hangs limply. Stiffness of the forearm when performing rotational movements is less pronounced.

When the neck of the radius is damaged, pain appears in the front of the joint and can also radiate to the forearm. Edema and hematoma are mild. A characteristic feature of this type of fracture is severe limitation of rotation of the forearm.

With a fracture of the coronoid process, pain appears on the anterior side of the joint, which increases with palpation. The functions of flexion and extension of the joint are limited. There is slight swelling above the joint, no deformities.

In a displaced fracture, passive extension is possible, while active extension causes severe pain.

Diagnostics and treatment

First aid

Treatment tactics are selected depending on the specifics of the fracture and the degree of damage. But in any case, the primary task is the complete immobilization (immobility) of the joint, consisting in the application of a splint. In this case, the arm is bent at an angle of 90 ° C, brought with the palm to the body and fixed in this position.

The hand, wrist and shoulder joints are also immobilized. Pain syndrome is relieved by analgesics.

Diagnostics

On palpation of the elbow along the fracture line, a sharp pain occurs. To make an accurate diagnosis, X-ray is performed, which is done in two projections, direct and lateral. Since fractures of the elbow joint are often accompanied by a rupture of the annular ligament, an image of the condyles of the humerus and the upper third of the bones of the forearm is also taken.

X-ray examination will clarify the location and type of the fracture, on the basis of which the treatment tactics will be determined. In some cases, CT and MRI methods are additionally used (for intra-articular fracture).

With a fracture with displacement, passive extension in the elbow remains, but with active extension, the pain increases sharply. With a fracture without displacement, there is mainly limited movement in the joint.

Treatment

With a slight displacement of the bones, up to 5 mm, the joint is reduced. In other cases, with more pronounced displacements, a surgical operation is required, during which the affected area is opened, the correct position of all bones is restored, and osteosynthesis methods are used (parts of the bones are fastened with special clamps, plates and knitting needles). If necessary, the damaged radial head is removed and replaced with an endoprosthesis. Then a plaster splint is applied to the damaged area.

Before surgery, a course of drug treatment is prescribed to reduce edema and hematoma. Venous outflow is improved with an elevated position of the elbow joint. With an open fracture, the operation should be performed within 24 hours after the injury.

With a fracture of the neck of the radius without displacement, the plaster cast is worn for two to three weeks, with a fracture of the coronoid process - for three to four weeks. A plaster cast is applied to the entire area from the fingers to the humerus, the elbow joint is fixed in a bent position.

After 4 weeks, the plaster splint is periodically removed for 15-20 minutes a day to develop the joint. The total duration of treatment, including the rehabilitation period, is one and a half to two months.

For a fracture with displacement, the plaster cast is applied after surgery for a period of 4-6 weeks. The total duration of treatment, including the rehabilitation period, is 2-3 months. The pins are removed several months after the injury.

On the subject: Pain in the elbow joint: what to do?

Rehabilitation period

Rehabilitation therapy includes:

• Physiotherapy (exercise therapy);
• Massage;
• Physiotherapy.

Elbow development through exercise plays a very important role in the recovery process. Neglect of exercise therapy can lead to partial or even complete loss of joint mobility.

In the first stage, which begins on the second day after the application of the plaster cast, exercises are performed for the joints free from plaster - the wrist and shoulder, as well as for the fingers, since the muscles responsible for the movement of the fingers come from the elbow joint. It is also recommended to periodically put your hand behind your head while in a supine position (for example, put it behind your head on a pillow), while straining the muscles of the shoulder and forearm. This stimulates lymphatic drainage and helps relieve puffiness. Isotonic muscle contractions (tension without movement) under the plaster should be started 7-10 days after the fracture. To reduce pain, you can combine these exercises with breathing techniques.

In the second stage, exercises are performed to flex and extend the elbow joint itself. For this, part of the plaster splint is temporarily removed from the forearm. The transition to the second stage of rehabilitation is carried out by the decision of the attending physician. With a fracture of the olecranon, the arm must not be bent at the joint, as this can provoke a second fracture.

These exercises can be done as follows:

• Sit at the table, put your hand on the table, and from this position raise and lower your forearm;
• Clasp the hands in the lock and bend-unbend both the injured and the healthy hand, lifting them behind the head.

You can do the exercises while sitting or standing, using a gymnastic stick or ball, or in the water, in the pool, or while taking a bath. A bath with sea salt is well suited for these purposes, since salt perfectly stimulates the restoration of lost functions and relieves pain.

The full-fledged development of the joint is passed after the final removal of the cast. You should start with slow bends in a gentle mode, while the shoulder lies on a horizontal surface (on the table), and the forearm is vertical.

A set of exercises

• Clasp the hands together and make movements that imitate throwing a fishing rod, alternately bringing the hands locked into the "lock" behind the ears from different sides;
• A similar exercise, but put your hands behind your head;
• Connect the hands behind the back;
• Put your hands behind your head, clasp your hands in the lock and stretch, directing your palms up;
• Roll a toy car on the table;
• Pick up a gymnastic stick and do flexion-extension at the elbows, holding the stick in front of you and above your head;
• Bend the elbow joint at a right angle and rotate the forearm around its axis;
• Roll the balls with the fingers of the injured hand.

All exercises should be done 3-4 times a day for 10-15 repetitions, starting from 4-6 and gradually increasing the load. Exercises should be performed with a healthy hand, since the elbow joint is a paired organ, they are interconnected. The elbow joint is the most difficult to develop. Therefore, sometimes to eliminate persistent disorders of articular movements, the use of special equipment is required.

Physical exercises are recommended to be combined with physiotherapy. For this, magnetotherapy is prescribed, electrophoresis, UHF, mud therapy can also be used.

Massage at the first stage of rehabilitation is contraindicated. At the 2nd and 3rd stages, you can massage the back and muscles of the arms above and below the damaged area (muscles of the forearm and shoulder). Gentle massage helps to restore motor functions, reduces pain, prevents muscle atrophy, and strengthens ligaments.

In case of a fracture of the elbow joint, it is strictly forbidden to carry weights and hang on the crossbar, overwork the muscles.

Intra-articular fractures are fraught with the development of persistent contracture (limited range of motion) or arthrosis in the distant future. That is why one should take seriously the complex of rehabilitation measures to restore the affected joint and follow all the instructions of the attending physician.

Nutrition after fracture

To help your body recover from injury as quickly as possible, you should pay attention to your diet. Collagen is of great importance for strengthening the ligaments, as well as vitamins C and E.

Collagen is found in poultry (especially turkey), fish (especially salmon species), oysters, mussels, shrimp, seaweed and other seafood, buckwheat, oatmeal, persimmons, and peaches. Vitamin C is rich in white cabbage and cauliflower, tomatoes, bell peppers, currants, rose hips, rowan berries, citrus fruits, strawberries, herbs (parsley, spinach), green peas. Vitamin E is found in cereal grains, carrots, sea buckthorn, soybeans, garlic, parsley, pumpkin and flax seeds, egg yolk, yeast, peanut butter, and nuts.

If you are overweight, diet is recommended. Excess weight puts additional stress on the joints, which leads to disruption of metabolic processes in them.

Author of the article: Kaplan Alexander Sergeevich | Orthopedist

Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.