Displaced forearm fracture
Content:
- Forearm fracture symptoms
- Typical causes of forearm fractures
- Diagnostics
- Forearm fracture treatment
Fractures of the forearm bones are the most common skeletal injury. According to statistics, the incidence of such injuries is 11% -30% of the total number of all closed fractures, and fractures of the diaphysis (body) of the forearm bones account for 53.5% of injuries to the bones of the upper extremities. An elderly person, a young person, or a child can get such an injury.
A bit of anatomy. The forearm is formed on the basis of two bones: the ulna and the radius. Between themselves they are connected by an interosseous membrane. Determining the location of these bones is simple: the ulna is on the side of the little finger, and the radius is on the opposite, where the thumb is. One bone or both can break. The severity of the fracture and its treatment directly depends on which part of the forearm bones is damaged: the upper third, middle or lower.
Forearm fracture symptoms
The signs of this damage depend on what type of fracture you had to face.
- Fracture of the body of the ulna. Human movements are limited. Deformation and swelling are observed. Squeezing and feeling the forearm causes severe pain.
- Fracture of the radius. The forearm is deformed, the patient experiences sharp pains when palpating the affected area, there is mobility of fragments. The person cannot actively rotate the forearm.
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Fracture of the diaphysis of both bones. A common injury, almost always accompanied by the displacement of bone fragments. The shortening and deformation of the forearm is clearly expressed. Usually, the injured person holds the injured limb with his good hand. Palpation, lateral compression of the forearm causes intense pain throughout, with intensification at the site of the fracture. The mobility of the fragments is observed.
- Radial fracture in a typical location. A similar injury is typical for older women. The wrist area of the forearm is swollen. Deformation is visible. Axial loading and palpation causes severe pain. Sensory impairment in the fourth finger of the hand may be detected, indicating concomitant damage to the nerve branches.
Typical causes of forearm fractures
It is possible to break the bones of the forearm as a result:
- falling on the upper limb bent at the elbow or hitting this area;
- direct blow to the forearm;
- falling on a straight arm;
- protection against impact with a bent and raised forearm;
- falling on the hand, leaning on the palm, or rarely, on the back of the hand;
- sharp angular deformity of the forearm.
Diagnostics
To make a diagnosis, a doctor needs a clinical examination (external examination, probing the site of injury) and the results of an X-ray examination.
Forearm fracture treatment
With an isolated diaphyseal fracture with displacement of the ulnar and radius bones, treatment begins with reduction. This procedure is required for all types of displaced fractures. Its detailed description will be below.
When the reposition is carried out, a plaster splint is applied to the patient's bent forearm, which should cover the areas of the wrist and elbow joints. The term of immobilization in case of a fracture of the ulna is 4-6 weeks, of the radius - from five to six weeks.
Treatment of a forearm fracture with displacement of bone fragments is still one of the most difficult tasks of modern traumatology. Simultaneous reduction with such localization of the fracture is extremely difficult. Even more difficult is the long-term retention of bone fragments in the correct position.
Reposition begins with an examination of radiographs. It can be performed manually or using special devices and is performed under local anesthesia.
For the rotary installation of the fragments, stretching is performed, then the surgeon manually matches the ends of the broken bones. Then, without weakening the traction and in the position achieved by the reduction, a splint is applied to the damaged area. X-rays are taken to check the results. If the reduction is successful, then the dressing is transformed into a circular one.
If the patient has massive edema, the splint remains until it disappears. When the swelling subsides, the patient needs to take a control X-ray to prevent re-displacement of bone fragments. After that, you can apply a plaster cast circular bandage for 10-12 days.
Starting from the second day, the patient should move the fingers, and on the 3-4th day - the shoulder joint. In addition, the patient must learn to perform rhythmic relaxation and tension of the muscles of the forearm, hidden by a plaster cast.
At the end of the immobilization period, the plaster cast is removed and the patient is prescribed therapeutic exercises and physiotherapy. The average recovery time is 12-14 weeks.
However, in the overwhelming majority of cases, doctors resort to surgical treatment of such fractures, since the elimination of all primary displacements and the prevention of secondary ones often fail. The problem lies in the fact that due to the tension of the interosseous membrane, the fragments of the ulna and radial bones come closer together.
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Surgical treatment consists of open reduction and osteosynthesis. The operation is best done on the second or fourth day after the injury. It is performed under general anesthesia.
Access to the bones is provided by two separate incisions. First, surgery is performed on the ulna. The ends of its fragments are isolated and set, then osteosynthesis is performed using metal clamps (metal plates, rods, needles, wire sutures, etc.). Then a similar manipulation is performed on the radius.
At the end of the osteosynthesis, a plaster cast is applied to the limb bent at a right angle. Usually the period of immobilization is 10-12 weeks, sometimes it can be increased.
After the bandage is removed, the patient is assigned to gymnastics, massage, physiotherapy and mechanotherapy. It takes 14 to 18 weeks to recover.
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.
