Closed fracture of the coronoid process of the ulna. Coronoid process of the elbow joint

The information on this site is not a guide to self-medication! Consultation with your doctor is mandatory!

Carrying out an X-ray examination in a lateral projection clarifies the nature of the fracture. It is also necessary to take into account the age-related features of ossification of the upper epiphysis of the ulna. The ossification nucleus in the olecranon appears in the 10-12th year of life. The epiphyseal line, which disappears by the age of 18-20, is often mistaken for a fracture.

Forearm fractures

Possible causes of fracture

The elbow joint is formed by the connection of the bones of the forearm and the proximal (lower) part of the shoulder. Fractures in the area of the elbow joint include: a fracture of the olecranon, a fracture of the head and neck of the radius, and a fracture of the coronoid process of the ulna.

During palpation examination, pain is noted in the area of the fracture; in some cases, a discrepancy (diastasis) between bone fragments is determined (in case of a displaced injury).

A characteristic sign of a fracture is pain at the site of injury, swelling, the presence of subcutaneous hemorrhage and limitation of movement in the joint.

The mechanism of injury is a fall on an outstretched arm. Avulsion fractures are possible due to excessive sudden contraction of the biceps muscle, which is attached to the coronoid process.

Treatment

are one of the most common injuries of the musculoskeletal system. The term “forearm fracture” itself is not particularly correct. It is preferable to talk about

Olecranon fracture

Passive (small amplitude) extension movements are preserved, but active extension and flexion of the forearm provoke a sharp pain syndrome. In the absence of displacement, the pain is not as pronounced; there is only a significant limitation of motor functions in the damaged area.

The diagnosis is made on the basis of complaints, examination and radiological diagnostic methods.

ContentsAt the first stage, which begins on the second day after applying the plaster cast, exercises are performed for the joints free of plaster - the wrist and shoulder, as well as for the fingers, since the muscles responsible for the movements of the fingers come from the elbow joint. It is also recommended to periodically place your hand behind your head while lying down (for example, placing it behind your head on a pillow), while straining the muscles of your shoulder and forearm. This stimulates lymphatic drainage and helps relieve swelling. Isotonic muscle contractions (tension without movement) under a cast should be started 7-10 days after the fracture. To reduce pain, you can combine these exercises with breathing techniques. Neurological symptoms may appear - tingling and numbness in the forearm, hand and fingers, as damage to the nerve fibers occurs;

Pick up a gymnastic stick and do flexion-extension at the elbows, holding the stick in front of you and above your head; In a displaced fracture, passive extension in the elbow is maintained, but with active extension, the pain increases sharply. In case of a non-displaced fracture, there is predominantly limited movement in the joint.

Diagnosis and treatment

In case of a non-displaced fracture, a deep posterior plaster splint is applied from the shoulder joint to the base of the fingers. When placing a cast, the arm must be bent at the elbow joint to 150-160°. This relaxes the triceps brachii muscle. The fixation period reaches 3 - 4 weeks. Starting from the first days of therapeutic immobilization, exercise therapy is prescribed in free joints. Physiotherapy is also indicated. Treatment is carried out similarly for fractures with slight displacement of fragments, which is eliminated by straightening the forearm. Fixation is carried out in the position in which reposition of the fragments has been achieved. Working capacity is restored after 6-8 weeks. In case of easily removable displacements of fragments of the olecranon process, various types of closed osteosynthesis are used to keep them in the correct position (wires with stops in the Kirschner arch, closed transosseous suture, etc.). Subsequent management of patients is the same as for non-displaced fractures. Fractures with severe displacement of fragments are subject to surgical treatment.

injuries

Diagnostics

is a common hand injury. With a fracture of the olecranon, pain is noted along the back of the elbow joint, pain can radiate to the shoulder and forearm. Swelling and bruising extend to the anterior surface of the elbow joint, which is associated with the outpouring of blood in the area of the elbow joint. Also, with a fracture of the olecranon, active extension in the elbow joint is impaired, because the triceps muscle of the shoulder is attached to the olecranon, which is responsible for extending the forearm. Rotational movements of the forearm (supination and pronation) are less affected. The crunching of fragments and visible deformation are felt when there is displacement of the fragments.

The X-ray examination is carried out in 2 projections, and in the image it is necessary to visualize the condyles of the humerus bone and the upper part of the forearm bones - a violation of the integrity of the olecranon process is often combined with damage to the capsular-ligamentous apparatus: rupture of the radial ligament.

Treatment depends on the type of fracture. Without displacement of fragments, conservative therapy is more often used; when bone elements are displaced, surgical intervention is used.

Treatment

Among the fractures of the coronoid process there are fractures

Damage to muscles, blood vessels, nerves, and skin in case of an open fracture.

Indications for surgical treatment of an olecranon fracture:or

Fracture of the olecranon: a) without displacement, b) with displacement

Complex conservative treatment is prescribed for injuries of the elbow joint without displacement:

The prognosis is usually favorable.

tops

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

Divergence of fragments by 2-3 mm or more.

damage

With a fracture of the head and neck of the radius

Set of exercises

A plaster splint: from the wrist joint to the upper part of the shoulder, while the limb is fixed in a bent position at the elbow joint. The period of wearing a plaster cast is up to 28 days, and it can be removed for a short time (after 15 days) to perform special exercises that restore motor activity.

In the vast majority of cases, a fracture of the olecranon process occurs under the influence of a force directed perpendicularly to the bone formation. This usually occurs when falling on the elbow (from the back) or when there is a blow to the area where the olecranon is palpated with a heavy object.

and fractures

Violation of the congruence of the articular surface (when fragments are displaced to the side),

forearms. The leading principle in the treatment of such pathology is savings. This is due to the complexity of the structure of the segment and the function of the forearm for human activities. There is not a single treatment method in traumatology that would not be used for forearm injuries. It is essential not only to eliminate fractures and dislocations, but also to eliminate all damaged tissues of the segment with restoration of the function of the forearm and hand.

The pain is felt on the front surface of the elbow joint and may radiate to the forearm. Bruising and swelling are minor. The crunching of fragments is rarely heard, and visible deformations are not observed, even when the fragments are displaced. A distinctive feature of this fracture is a sharp limitation of the rotational movements of the forearm.

Therapeutic exercise. Gymnastics can be carried out from the first day after injury - to develop non-immobilized joints.

Due to the anatomical features of the formation (massive body and narrowed apex with weak bone architecture), fractures are most often diagnosed in the upper and middle parts of the process. If the triceps tendon is not involved, the fracture is characterized by minimal or no displacement of the fragments.

Nutrition after a fracture

process body

Clutch your hands and bend and straighten both the injured and healthy arm, lifting them behind your head.

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Comminuted fractures with displacement of fragments in the presence of sufficiently large fragments.

Possible causes of fracture

1. Fracture of the olecranon process of the ulna

Types of Elbow Fractures

Fracture of the coronoid process of the ulna

The treatment tactics for fractures, if the displacement is slight, are identical. Fixation of the elbow joint with a plaster splint is carried out in a position in which complete reposition (comparison) of displaced bone fragments is maintained.

In case of injury with damage to the aponeurosis of the triceps brachii muscle, fragments of the olecranon process are displaced upward, as the triceps tendon “pulls” the damaged elements to the shoulder area, increasing the distance between the parts of the process and preventing their rapid fusion.

with or without offset.

You can do the exercises sitting or standing, using a gymnastic stick or ball, as well as in water, in a 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.

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.

Heads and necks of the radius (occurs when falling with emphasis on a straight arm);

Optimal for intra-articular fractures is

Extra-articular (the fracture line passes through the apex of the olecranon process)

is accompanied by pain on the anterior surface of the elbow joint, the pain intensifies when palpated. Flexion and extension of the elbow joint are limited. There is a slight swelling above the elbow joint, no deformities are observed.

Surgical intervention is used:

When the body or base of the process is fractured, they speak of intra-articular fractures, and if the apex is damaged, they speak of extra-articular ones. Clinical diagnosis is difficult, since there are no manifest symptoms, and the clinical manifestations resemble a bruise: pain in the joint, swelling in the ulnar fossa. K Full development of the joint begins after the final removal of the plaster. You should start with slow bending in a gentle mode, while the shoulder lies on a horizontal surface (on the table), and the forearm is located vertically.

When the coronoid process is fractured, it appearsIf the elbow joint is fractured, it is strictly forbidden to carry heavy objects, hang on the crossbar, or overwork the muscles.

In case of a displaced fracture, plaster 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.

Diagnosis and treatment

Coronoid process of the ulna (occurs rarely, but is usually combined with dislocation, displacement, or injury to the forearm);

osteosynthesis with a tightening loop

Diagnostics

Intra-articular (the fracture line passes through the middle of the semilunar notch and the base)

For fractures in the area of the elbow joint, first aid consists of immobilizing the elbow joint with a splint from improvised means, but you should remember that if you cannot apply a splint yourself, it is better not to experiment, but to tie your arm in a scarf. The pain syndrome is eliminated by any available analgesics: ketorol, nimesulide, analgin. Do not move the damaged joint and try to set the fracture yourself.

If the discrepancy between the displaced bone segments is more than 2 mm.

Treatment

Sometimes the damage is combined: along with a fracture of the olecranon, a dislocation occurs in the radial (Malgenya injury) or elbow joints.

The rotational movements of the forearm are free, but active and passive flexion and extension are limited due to exacerbation of pain.

Clasp the hands together and make movements that imitate casting a fishing rod, alternately turning the hands linked into the “lock” behind the ears from different sides; Pain on the front 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.

On topic:

Epicondyles of the humerus.. This treatment method allows you to begin early movements in the joint. It is produced immediately upon admission of the patient or after healing of abrasions in the area of surgical intervention.

2. Fracture of the coronoid process of the ulna

For diagnosis, an X-ray examination is performed. In some cases, computed tomography is done to confirm the diagnosis.

If the integrity of the articular surface is violated.

A fracture of the olecranon can occur not only under the action of a direct force, but also with a sharp contraction of the triceps muscle of the shoulder. Such fractures are called avulsion fractures.

Local pain cannot be detected by palpation due to hemarthrosis and a significant array of muscles. Palpation reveals only pain along the anterior surface of the joint.

A similar exercise, but bring your hands behind your head;

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

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

Pain in the elbow joint: what to do?

Fractures are also divided into intra-articular and periarticular, closed and open, with and without bone displacement. In 53% of cases, a fracture involves damage to just one bone. With closed fractures, which are more common, the bones do not damage the soft tissues. With open fractures, the integrity of the skin is compromised, an open wound appears and bone tissue comes out.

Relatively rare injury. A fracture of the coronoid process usually accompanies a posterior dislocation of the forearm or multiple fractures of the bones that form the elbow joint.

3. Fracture of the head and neck of the radius

Set of exercises

Fracture of the olecranon without displacement

If multi-fragmented injuries are diagnosed.

There are several criteria by which the tactics of further treatment are determined:

Positive Sklyarenko symptom: full impulse tension of the biceps muscle is impossible due to exacerbation of pain.

Place your hands behind your back;

Treatment tactics are chosen depending on the specifics of the fracture and the degree of damage. But in any case, the first priority is complete immobilization (ensuring immobility) of the joint, which consists of applying a splint. In this case, the arm is bent at an angle of 90 degrees, brought with the palm to the body and fixed in this position.

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

Rehabilitation therapy includes:

Sharp pain in the elbow joint and forearm, which can spread to the wrist joint and fingers;

Mechanism of injury

4. Fracture of the diaphysis of the ulna

are treated by applying a plaster cast from the upper third of the shoulder, with the capture of the elbow and wrist joints. The cast must be worn for 6 weeks.

According to indications, osteosynthesis is performed (comparison of segments with additional fixation). Surgical treatment tactics are recommended that allow you to begin developing the damaged bone joint as early as possible.

Nutrition after a fracture

Depending on the location of the fracture - the body of the process, the apex or the middle part - in the area of the trochlear notch.

Compaction of fragments of the coronoid process between the articular surfaces leads to a block of the elbow joint.

Place your hands behind your head, clasp your hands and stretch, pointing your palms up;

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

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Fractures of the coronoid process of the ulna: symptoms, diagnosis, treatment

Therapeutic physical education (physical therapy);

Significant limitation of mobility in the joint or complete immobility;

. Usually - indirect. Occurs when falling onto an outstretched arm or the back of a bent forearm. This fracture is intra-articular. The displacement of fragments is usually small.

5. Fracture of the diaphysis of the radius If the fracture is displacedThe operation is performed immediately after the final diagnosis or after restoration of the skin (healing of wounds and abrasions) in the area of the upcoming surgical intervention. By nature - open and closed fracture, with displacement of fragments or without this complication.X-ray examination makes it possible to establish a diagnosis due to the appropriate position of the hand.

Symptoms of fractures of the coronoid process of the ulna

Roll a toy car on the table;

When palpating the elbow along the fracture line, a sharp pain occurs. To make an accurate diagnosis, radiography is performed, which is done in two projections, frontal and lateral. Since a fracture of the elbow joint is often accompanied by a rupture of the annular ligament, photographs of the condyles of the humerus and the upper third of the bones of the forearm are also taken.

Massage;

As the opposite phenomenon - pathological, unusual mobility in any one direction, for example, lateral;

Diagnostics

Clinical picture.

6. Fracture of the radius in a typical location

, then they perform an operation and fix the fragment using metal wire and knitting needles. Reduction of a displaced fracture rarely brings a positive result, which is associated with tension on the fragment by the triceps brachii muscle. Next, a plaster splint is applied for 4-6 weeks. After removing the plaster, rehabilitation begins; the total treatment period is 2-3 months. The needles are removed several months after the injury.

Treatment

Conservative method

After surgical treatment, the upper limb is fixed with a scarf. Active development of the damaged joint is possible 3-5 days after surgery; full motor functions are restored after 20-35 days. The fixing elements used for osteosynthesis (wire loop, Kirschner wires) are removed after at least 3 months.

According to the location of the bone tissue damage - direct, oblique, transverse fracture, simple or comminuted.

Surgery

The hand is placed so that the olecranon process and the internal epicondyle are adjacent to the cassette, and the forearm is semi-flexed and semi-pronated (according to B. Bogachevsky).

Pick up a gymnastic stick and do flexion-extension at the elbows, holding the stick in front of you and above your head;

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

The elbow joint has a complex structure: it is formed by the humerus, ulna and radius bones, 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.

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Physiotherapy.

Swelling and formation of severe hematoma due to hemorrhage into the joint cavity;

There is swelling (edema) in the area of the elbow, palpation - diffuse pain, impaired flexion of the elbow joint.

Extension fracture (Colles)

With a fracture of the neck and head of the radius without displacement

In case of Malgenya injury (damage to the integrity of the bone in combination with rupture of the ligament and dislocation of the head of the radial bone), osteosynthesis is performed using a long screw and reduction of the head.

With and without compression changes in the bone tissue of the appendix.

In this position, the coronoid process completely emerges from the shadow of the head of the radius and the X-ray rays are centered on it.

Bend the elbow joint at a right angle and rotate the forearm around its axis;

In a displaced fracture, passive extension of the elbow is maintained, but with active extension the pain increases sharply. In case of a non-displaced fracture, there is predominantly limited movement in the joint.

Damage mechanism

Large vessels and nerves pass through this joint, responsible for the blood supply and innervation of the forearms and hands. 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, surgery is performed to ensure proper bone fusion.

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

Neurological symptoms may appear - tingling and numbness in the forearm, hand and fingers, as nerve fibers are damaged;

Diagnostics.

Damage to Monteggia

plaster immobilization lasts 2-3 weeks. If there is a displacement, then they try to fix it, in case of failure, an operation is performed to remove the broken bone fragment. The total treatment period is 1-2 months.

Types

Treatment of chronic injuries, when complete fusion of bone fragments has not been achieved, also involves the use of surgical intervention. Especially if the joint mobility has not been fully restored, even after complex rehabilitation by “classic” methods.

By involvement of nearby structures - isolated (local fracture in the process) or combined - with fractures and dislocations of adjacent bone formations and joints.
Fractures of the coronoid process are treated conservatively: the forearm is bent to an angle of 50-60 ° with supination of the forearm and immobilized with a posterior plaster splint for up to 3 weeks.
Roll the balls with the fingers of the injured hand.
If the bones are slightly displaced, up to 5 mm, the joint is realigned. 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 applied (parts of the bones are fastened with special fixators, plates and knitting needles). If necessary, the damaged head of the radius is removed and replaced with an endoprosthesis. Then a plaster splint is applied to the damaged area.
At the same time, the elbow joint is the most stable in the human body, which provides great opportunities for compensation in case of such an injury. Elbow fractures account for an average of 20% of all intra-articular fractures.
At the first stage, which begins on the second day after applying the plaster cast, exercises are performed for the joints free of plaster - the wrist and shoulder, as well as for the fingers, since the muscles responsible for the movements of the fingers come from the elbow joint. It is also recommended to periodically place your hand behind your head while lying down (for example, placing it behind your head on a pillow), while straining the muscles of your shoulder and forearm. This stimulates lymphatic drainage and helps relieve swelling. Isotonic muscle contractions (tension without movement) under a cast should be started 7-10 days after the fracture. To reduce pain, you can combine these exercises with breathing techniques.

Damage to muscles, blood vessels, nerves, and skin in case of an open fracture.

If a fracture of the coronoid process of the ulna is suspected, an x-ray examination is mandatory. However, in conventional projections it is not always possible to recognize this damage. In order to remove the process from the imposition of the shadow of the head of the radius, the hand should be placed so that the olecranon and medial epicondyle of the shoulder are in contact with the cassette. The forearm is placed in a position midway between pronation and supination and flexed at an angle of 160°. A lateral projection is also necessary.
(Monteggia) - a combination of a fracture of the ulna in the proximal third with a dislocation of the head of the radius.
Fracture of the coronoid process

Symptoms

The main objective of the complex of rehabilitation measures after treatment is to restore motor activity of the injured joint. Physical therapy gives the best results. Conducting classes can be divided into 3 stages.

By location, intra-articular fractures and fractures outside the capsule of the humeral-elbow joint are distinguished.

In the case of a block of the elbow joint and in case of comminuted fractures, surgical treatment is indicated.
All exercises should be done 3-4 times a day for 10-15 repetitions, starting with 4-6 and gradually increasing the load. The exercises must also be performed with the healthy arm, since the elbow joint is a paired organ and they are interconnected. The elbow joint is the most difficult to develop. Therefore, sometimes the use of special equipment is required to eliminate persistent disorders of joint movements.
Before surgery, a course of drug treatment is prescribed to reduce swelling and hematoma. Venous outflow improves with an elevated position of the elbow joint. In case of an open fracture, the operation should be performed within 24 hours after the injury.

The cause of the fracture may be a fall on the elbow or a straightened arm, a direct blow to the olecranon, a previous dislocation of the joint, or an injury to the forearm. The likelihood of a fracture increases with weakness of the elbow ligaments and tendons.

Diagnostics

At the second stage, exercises are performed to flex and extend the elbow joint itself. To do this, part of the plaster splint is temporarily removed from the forearm. The transition to the second stage of rehabilitation is carried out according to the decision of the attending physician. If the olecranon is fractured, you should not bend your arm at the joint, as this may cause a re-fracture.
When the olecranon is fractured, pain occurs in the back of the joint, which can radiate to the forearm and shoulder. Swelling and hematoma extend to the anterior surface of the joint. The function of arm extension is impaired, since the triceps, which is responsible for extension of the forearm, is attached to the olecranon process. The injured arm hangs limply. Stiffness of the forearm during rotational movements manifests itself to a lesser extent.
Treatment

Treatment

Damage to Galeazzi

requires plaster immobilization for a period of 3 to 4 weeks. The total duration of treatment with rehabilitation is 1-2 months.
Passive flexion and extension movements (within a plaster cast) to relieve swelling of soft tissues and stimulate blood circulation. They are carried out in the first days after injury.

Combining a large number of criteria and characteristics, doctors identified 3 types of olecranon fracture:

Surgery is necessary in cases where there is blockage of the elbow joint or significant displacement of the elbow joint.

Physical exercise is recommended to be combined with physiotherapy. For this purpose, magnetic therapy is prescribed; electrophoresis, UHF, and mud therapy can also be used.
With a fracture of the neck of the radius without displacement
The olecranon process of the ulna is a typical location for damage to the elbow: it is not protected by a muscular frame and always takes the first blow. However, olecranon fractures are quite rare, occurring in 0.8-1.5% of cases.

These exercises can be performed as follows:

In case of damage to the neck of the radius

If the fracture of the coronoid process is not accompanied by a clinically significant displacement, the elbow and wrist joints are immobilized with a posterior splint plaster cast in the flexion position. Immobilization is carried out at a right angle for 2 weeks. Then a removable splint is applied for 1-2 weeks. Indications for surgical treatment are:

(Galeazzi) - a combination of a fracture of the diaphysis of the radius (usually in the distal third) with a dislocation of the ulna in the distal radioulnar joint.

From the first days after the injury, we actively move the fingers of the injured hand and the shoulder joint. After 7-10 days, we begin isotonic muscle contractions (muscle tension without making movements) under the cast.

Rehabilitation

First type: fracture without displacement of fragments with the presence of splintered injuries (1B) or without them (1A).

The outcome of surgery largely depends on the time from the moment of fracture to the operation itself. Small fragments that block movement in the elbow joint are removed, and large fragments are sutured with nylon, lavsan or catgut to the mother bed.

Massage at the first stage of rehabilitation is contraindicated. At the 2nd and 3rd stages, you can massage the back and arm muscles above and below the damaged area (forearm and shoulder muscles). A gentle massage helps restore motor functions, reduces pain, prevents muscle atrophy, and strengthens ligaments.
The cast is worn for two to three weeks, and for 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.

Other types include fractures:

Which doctor treats

Sit at the table, put your hand on the table, and from this position raise and lower your forearm;

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Fractures of the coronoid process of the ulna / Diseases / Healthy Community

What are Fractures of the coronoid process of the ulna -

What causes Fractures of the coronoid process of the ulna:

Impossibility of closed reduction with large displacement.

Symptoms of Fractures of the Coronoid Process of the Ulna:

Divergent (divergent) radioulnar dislocation

Treatment of fractures of the coronoid process of the ulna:

2 weeks after the injury, physiotherapy treatment is prescribed - magnetotherapy. After removing the plaster, the range of procedures expands, ozocerite, UHF, electrophoresis, sea salt baths and mud therapy can be used.

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Fracture of the ulnar joint (elbow) - Causes, symptoms and treatment. MJ

To prevent relapse (repeated fracture), forced exercises are performed to restore flexion function.

Symptoms of an elbow fracture

Second type: displaced fracture, stable - functions in the elbow joint are preserved, the ligaments are not damaged (collateral), the distance between the displaced areas is no more than 3 mm. Without fragments - 2A, with the presence of fragments - 2B. After the operation, the joint is immobilized with a permanent plaster splint for 2-3 weeks, then it is replaced with a removable one, also for several weeks.

If the elbow joint is fractured, it is strictly forbidden to carry heavy objects, hang on the crossbar, or overwork the muscles.

Clutch your hands and bend and straighten both the injured and healthy arm, lifting them behind your head.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 limited rotation of the forearm.

First aid for a broken elbow

Infringement of a bone fragment between the articular surfaces.

Diagnostics for a fracture of the elbow joint

- separation of the radius and ulna with rupture and proximal displacement of the wrist, with dislocation of the ends of the ulna and radius in the distal radioulnar joint.

Elbow fracture treatment

After removing the plaster cast, we begin to develop movements in the elbow joint of the injured arm. All exercises are done together with the elbow joint of the healthy side for 10-15 repetitions, with a gradually increasing load, 3-4 times a day. We perform part of the exercises in a bath with sea salt, which improves function recovery and relieves pain. Physiotherapeutic procedures are added to therapeutic exercises: heating with paraffin or ozocerite.

Third type: fracture with displacement and impaired function in the joint (fracture-dislocation) - 3A (without splinters) and 3B (with splinters).

Intra-articular fractures are fraught with the development of persistent contracture (limited range of motion) or arthrosis in the long term. That is why you should take the complex of rehabilitation measures to restore the injured joint very seriously and follow all the instructions of the attending physician. In case of a displaced fracture, plaster 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.

Coronoid process of the ulna (occurs rarely, but is usually combined with dislocation, displacement, or injury to the forearm); You can do exercises while sitting or standing, using a gymnastic stick or ball, as well as in water, in a 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.

Rehabilitation for an elbow fracture

When the coronoid process is fractured, it appears

Comminuted fracture.

Accounts for 1 to 1.5% of fractures. More often observed in adults and older children.

An approximate set of exercises for developing the elbow joint:

We close our hands with a lock, do exercises like throwing a fishing rod, alternately placing the lock behind the left and right ear; The same, but throwing the hands behind the head; We try to close our hands on our backs; We put our hands behind our heads, close our hands into a lock and stretch, straightening the lock with our palms up; We take a children's car in our hand and roll it along the table, making movements in the elbow joint; We play with the ball; We do various exercises with a gymnastic stick, focusing on flexion and extension at the elbow joint; After a sufficient reduction in pain, we begin exercises with dumbbells (weighing no more than 2 kg); Developing rotational movements in the forearm (supination and pronation) - bend the elbow joint to an angle of 90 degrees, then make movements with the forearm around its axis, it is important to make rotational movements with the forearm, not the shoulder.

All exercises should be carried out under the supervision of professionals, the load on the damaged area should be moderate and "metered". Otherwise, there may be a violation of the position of the reposited fragments, the formation of deformations of the bone tissue (for example, "spurs").

The patient complains of intense pain, with impaired mobility of the elbow joint. The upper limb occupies a forced position - it is lowered in an unbent form along the body.

Prognosis for elbow fracture

The olecranon (Olecranon) is part of the bone of the same name in its proximal section and one of the most important functional segments of the elbow joint.

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

An elbow fracture is an extremely complex injury. It requires careful diagnosis, long-term treatment and rehabilitation. Such injuries account for 1% of the total number of recorded limb fractures. But internal damage to the elbow joint is about 30%.

You will learn

The elbow joint connects the bones of the lower part of the humerus, the ulna and the radius. At the end of the ulna is a process of the same name, which is easily palpable. It is covered with articular cartilage, which connects all the bones into a single mechanism. The triceps, a muscle responsible for extending the arm, is attached to the process.

There is a general international classification of fractures. In accordance with it, injuries are distinguished with or without displacement, open or closed, compression. There are also simple, oblique, transverse and comminuted fractures.

There are three typical fractures of this part of the limb:

olecranon;
head and neck of the radius;
coronoid process of the ulna.

Often the injury entails displacement of fragments at the level of the apex of the process. There are frequent cases of damage inside the joint, which is especially dangerous. The triceps is attached to this place, which, tensing, pulls the fragments towards the shoulder. This makes treatment and healing difficult.

Causes and symptoms

A fracture of the arm in the elbow joint most often occurs due to a fall on the elbow or on the outstretched arm. In this case, the radius bone or process is most often injured. The latter may be damaged after a direct blow to it. Forearm injuries can lead to such consequences.

Patients who seek help and are subsequently diagnosed with this condition often complain of severe pain in the elbow joint and dysfunction. A distinct crunching sound that was heard during the injury is also noted. After this, the patient intuitively extends the injured arm along the body.

Visually, injury can be identified by the following symptoms:

swelling of the elbow joint;
its deformation;
limited extension and flexion of the arm;
severe pain when feeling the appendage;
bruises.

If the injury occurs with displacement, atypical skin retractions are noticeable in the joint area. When there is no displacement, there is no deformation, but the function of the hand does not suffer. Only a slight limitation of joint mobility is noticeable. Therefore, it is difficult to establish an accurate diagnosis without an x-ray.

First aid to the victim

You can alleviate the suffering of the victim before providing him with medical assistance by immobilizing the elbow joint. To do this, they collect and apply a splint from available means.

If you can’t make a splint yourself, the only sure way out is to tie your hand on a scarf. Never try to fix a fracture yourself!

After this, the victim should be given any strong painkiller: analgin, nimesulide, ketorol. Ice should be periodically applied to the fracture site to reduce pain and swelling.

Treatment

Treatment for an injury depends on its nature, as well as where exactly the injury occurred.

Fracture of the olecranon

If such an injury occurs without displacement, you can get by with conservative treatment. A splint bandage is applied to the arm, bent at 90° with the palm up, from the wrist joint to the upper third of the humerus. This is done in order to prevent swelling from developing, which can increase for another 6 days after the injury.

The patient must remain in this bandage for at least three weeks. It is removed periodically to develop the elbow joint.

If the olecranon fracture occurs with displacement, in this case surgery is necessarily indicated. The success of recovery depends on how accurately the fragments are combined and how correctly the joint is then developed.

Depending on the complexity of the fracture, the following is used to fix displaced fragments:

splint or orthosis;
screws;
titanium plate with screws;
knitting needles with a tightening loop.

Sometimes the bones at the site of the fracture do not heal, and the space between the fragments is overgrown with connective tissue. Then a pathological condition such as a false joint develops.

This injury is characterized by pain on the front of the elbow joint, which radiates to the forearm. In this case, the swelling and bruising are small.

During a fracture, the patient rarely hears a crunch; deformations are also invisible even with displacement. But the restriction of movement is pronounced.

If the fracture of the radial head occurs without displacement, treatment consists of immobilizing the limb for three weeks. When displaced through surgery, they try to reconcile the fragments, but this is not always possible.

Otherwise, the broken fragment is simply removed. This treatment can take up to two months.

In this case, the pain is felt on the front of the joint, and upon palpation it sharply intensifies. Flexion and extension are limited, there are no deformities, there is slight swelling.

It is treated with a plaster splint for four weeks, as well as rehabilitation for up to two months.

Complications

The most typical and difficult consequence of such a fracture is malunion of the arm and, as a result, loss of its activity. In this case, the patient is accompanied by a feeling of discomfort and sometimes pain. In some cases, arthrosis develops at the site of injury.

To prevent such complications, you must strictly follow all the recommendations of the attending physician regarding rehabilitation measures and restriction of activity in the postoperative period.

Complications can also arise as a result of surgery. For example, during surgery a wound or bone may become infected. It can penetrate even after manipulations have been performed, until the wounds have healed.

If during the postoperative period there is bleeding from the wound, the skin around it is cold and white or swollen, or your fingers, elbow or hand become numb, you should immediately consult a doctor.

To prevent this from happening, it is necessary to adhere to the rules of asepsis. Otherwise, additional antibiotic treatment is prescribed. Sometimes the applied plates, screws or brackets become loose, and then you have to do a second operation and tighten them.

Rehabilitation period

Since in an immobilized state the joints, muscles and tendons of the hand gradually atrophy, it is necessary to begin their development in time. To do this, special exercises are performed in different modes. Depending on the complexity of the fracture and the duration of treatment, the rehabilitation period can take from two weeks to two months. It consists of three main stages.

The first has two stages:

First, physical therapy exercises are prescribed, which are aimed at reducing swelling of the limb after surgery, improving blood circulation and, as a result, relieving pain. To do this, the patient must slowly bend and straighten his fingers and finger small objects with them.
At the second stage, when the fracture site begins to heal, you can bend and straighten your folded arms within the confines of the cast.

The second stage requires detailed development of the elbow joint. For this, exercise therapy exercises are performed, sitting or lying down, including with objects: a stick, a ball, dumbbells. Exercises in water are shown.

For a fracture of the elbow joint, the following exercises are done:

close your hands and slowly move them behind one ear, then the other, then behind the head;
move your hands behind your back and try to close them;
move your hands behind your head, clasp them, straighten your arms with your palms up, stretching;
roll a children's car on the table, straightening your arm at the elbow joint;
play with a ball;
exercise for extension and bending of arms with a gymnastic stick;
exercises with dumbbells up to 2 kg (after pain decreases);
practicing rotational movements of the forearm: bend your arm at a right angle and rotate your forearm around its axis.

Watch a video about physical therapy for an elbow fracture.

The elbow joint is very difficult to develop, so in exercise therapy it is often necessary to use special devices and simulators. In any case, you should not force the exercises, especially bending, to avoid a re-fracture. They are performed no more than 6 times, approximately 4 times a day.
Physiotherapeutic treatment is prescribed only at the third stage of rehabilitation. It includes uses:

paraffin;
ozokerite;
Physical therapy is still maintained.

During any period of rehabilitation, muscle overwork, movements that cause pain, and carrying heavy objects should not be allowed. If these recommendations are not followed, then in addition to a re-fracture, various bone deformities may occur.

For the same reasons, massage of the injured area is prohibited. But back and shoulder massage is allowed.

Only after significant and stable improvement is a gentle massage of the elbow joint prescribed. It prevents muscle atrophy, strengthens the ligamentous apparatus, and restores range of motion in it.

A fracture of the elbow joint can be considered one of the most complex fractures, especially when it comes to bone displacement. Usually the case ends with surgery and a long period of rehabilitation. Therefore, in the event of an injury, the victim should be provided with the necessary first aid, and the patient himself should subsequently strictly follow the advice of doctors.

Fractures of the coronoid process are rarely isolated and are more often found in combination with posterior dislocation in.

It is believed that isolated ones occur as a result of hyperextension with tension of the joint capsule and subsequent avulsion. When coronoid process fractures are associated with posterior dislocation, the mechanism is avulsion of the coronoid process due to impact with the distal humerus.

Pain and swelling are common in the cubital fossa. Fractures of the coronoid process are better identified on lateral radiographs, although oblique views may be necessary. A fragment of the radius may be displaced, as is observed in avulsion fractures, or impacted into the trochlea, which is often found in fracture-dislocations.

Treatment of coronoid process fractures

This fracture is often associated with dislocation of the ulna. A more detailed analysis of fracture-dislocations is presented in the next article.

Class B: type IA (small fragment), type IB (minimal displacement). Isolated, nondisplaced fractures are best treated by immobilization in a long posterior splint for 3 to 4 weeks. The elbow joint should be bent at an angle of more than 90°, the forearm should be in a supinated position. This is followed by active exercises with a support bandage. There is no uniform treatment strategy for these fractures, so early referral of the patient to a specialist is mandatory.
Class B: Type IIA (offset). Fracture dislocations require immediate open reduction by an experienced orthopedic surgeon.
Class B: type IIB (displaced in combination with posterior elbow dislocation). Fracture dislocations will be discussed in the article on elbow dislocations.
Fractures of the coronoid process are only rarely complicated by the development of osteoarthritis.

Part of the trochlear notch, which connects to it at the humerus. In the second case, the anterior process on the branch of the mandible, the place of attachment of the temporal muscle.

Structure of the lower jaw

The jaw apparatus is formed by 2 jaws - the upper fixed and the lower movable. The latter is articulated with the skull. The mandible has a horseshoe-shaped body and branches extending upward at an obtuse angle, which become thinner towards the end.

The anterior branch forms the coronoid process. The temporal muscle is attached to it. The correctness of jaw movements depends to a large extent on this process. If it is violated, the mouth simply will not open. The second process, posterior, is condylar, which forms an articulation with the skull - the temporomandibular joint (TMJ). Both processes have 2 surfaces - external and internal and 2 edges - anterior and posterior.

The anterior edge passes into the coronoid process, and the posterior edge into the articular process. There is a deep notch between them. The temporal ridge runs along the middle part of the coronoid process, and the tendon of the temporal muscle is attached to it.

The TMJ is a combined joint, so its movements can occur in 3 planes: the joint can rise and fall (opening and closing the mouth), vertical and horizontal displacements. The joint is supported by ligaments.

Pathologies of the lower jaw

All diseases related to the joints can also be found in the mandibular joint. The most common are arthrosis, arthritis, osteoporosis, congenital anomalies and injuries.

Of course, arthrosis is more often observed, in which degenerative-dystrophic changes in bone tissue occur in the limbs and spine, which receive heavy loads, but the joints of the skull are not immune from them.

Types of arthrosis of the jaw

One of the criteria for systematizing pathology is its etiology. Arthrosis can be primary (occurs after 50 years and is associated with aging of the body) and secondary (occurs against the background of existing diseases), it is more frequent.

Among the provoking factors are:

tooth loss;
broken bite;
maxillofacial injuries;
unsuccessful dental prosthetics;
dental operations;
chronic arthritis of the TMJ;
increased tooth wear;
grinding of teeth (bruxism).

According to the X-ray picture, arthrosis can be sclerosing and deforming. Signs of sclerosing:

compaction of bone tissue;
narrowing of the joint space.

Signs of a deforming form:

thickening of articular surfaces;
osteophytes;
at a late stage - a sharp deformation of the articular head.

The coronoid process is not part of the joint, but osteophytes in arthrosis necessarily cause its damage.

Injuries to the processes of the lower jaw

The most common type of injury is fractures. The lower jaw is a fairly fragile structure, so injuries are common. A coronoid fracture occurs when there is a strong blow to the chin from top to bottom. Treatment is complex and the rehabilitation period is long.

If the coronoid process of the jaw is broken, then when you try to open the mouth, the jaw moves towards the injury. This is accompanied by severe pain. An accurate diagnosis will be made with a lateral x-ray at the maximum opening of the patient's mouth.

Prevention of jaw fractures

The most frequent fractures of the jaw (fractures of the coronoid process of the lower jaw, including) were observed in children from 7 to 14 years old, which is associated with their increased physical activity.

So, preventive measures:

To avoid children falling from heights, they must be constantly supervised by adults.
When playing sports, personal protective equipment is required - knee pads, elbow pads, helmets, belts.
When driving in a car, child seats are required for children, and seat belts for adults.
Both adults and children need to try not to get into situations of fights and brawls with blows to the face or falls.
If we are talking about extreme sports, use protective equipment.
You should not test your teeth's strength by chewing hard nuts, etc.
Loads on the jaw must be adequate. You should not chew gum 24 hours a day.
In everyday life, you don't need to open your mouth too wide.

Elbow fracture

It is considered a complex injury and is reported in 20% of fracture cases. is quite complex, so an elbow fracture is considered dangerous due to many irreversible complications and very long healing.

Anatomy of the elbow joint

The elbow joint, when viewed from the front, consists of 3 bones: the ulna, radius and humerus.

Behind the joint sequentially:

brachial bone;
olecranon;
radius and ulna;
coronoid process of the ulna.

Any part of the joint can be injured, and treatment and symptoms will vary.

Causes of process fractures

A condyle fracture occurs due to direct trauma - if, during a fall from a height, the falling person stretched out his arm. In this case, the fracture is often displaced.

When the coronoid process of the ulna is fractured, we are always talking about an indirect injury - a fall on the back of the forearm with maximum flexion.

Humeral shaft fractures occur from a direct blow (bludgeon fracture). It usually happens during road accidents and fights.

In addition to these reasons, fractures of the coronoid process of the ulna can occur even with the most minimal impact of the bone. This is typical for osteoporosis, arthrosis, and osteoarthritis.

Process fracture

Isolated fractures of the coronoid process of the ulna are a rare occurrence. When a bruise or fracture occurs due to a fall from a height, the humerus, as if with force, knocks down the process and fragments it. In addition, it suffers from the posterior ones, but most often its damage occurs in general, its fracture is rare because it is deeply hidden by a significant layer of soft tissue. The base or the very top breaks. Comminuted fractures of the coronoid (medial) process practically do not occur.

Symptomatic manifestations

When examining the victim, severe swelling and elbow hematoma are noted due to damage to soft tissues. The joint itself is deformed, at the site of the protrusion of the condyle, the skin sinks (this is clearly visible in the first minutes of the injury, then swelling spreads and everything disappears).

A fracture of the coronoid process of the ulna may have mild symptoms or manifest itself as follows:

pain moving to the fingers;
immobility of the elbow joint - complete or partial;
swelling and hematomas.

There may also be external damage to the skin, muscles, blood vessels, and nerves.

If a fracture occurs with displacement of the fragments, the victim himself cannot straighten his arm at the elbow. Severe pain interferes. You can passively straighten your elbow. With a fracture of the coronoid process without displacement, movements in the elbow joint are possible, but very limited.

Diagnostic measures

Typically, for diagnosis it is necessary to take an x-ray in two projections: frontal and lateral. The situation with the coronoid process is different: pictures in 2 projections will not give results.

To diagnose, it is necessary to position the hand so that the process leaves the area where the shadow of the beam head is applied. To do this, the arm is positioned so that the process and epicondyle of the humerus are in contact with the cassette. The forearm should remain semi-pronated and flexed at an angle of 160.

Pronation means turning the hand inward. The direction of the x-ray should be aimed at the coronoid process. Then it becomes visible, comes out of the shadow of the radius, and diagnosing the fragment becomes 100% successful.

Treatment

Treatment of the ulna for a fracture of the coronoid process can be of two types: conservative or surgical. With improper therapy or its complete absence, the most common complication is malunion, which causes the joint to become immobile or have limited mobility.

Conservative treatment

When treating a fracture of the coronoid process, reposition is not required, since there are no pronounced displacements. Treatment of the appendix is carried out on an outpatient basis for 6-8 days, while the arm is fixed with a posterior plaster splint, the forearm is bent at an angle of 60-65 degrees. Then a complex of functional treatment is prescribed. Working capacity is restored already on the 6th day.

Immobilization

Apply for 3-4 weeks. It starts from the fingers and ends with the shoulder. After 3 weeks, the splint is removed, and the joint is to be developed. The entire course of treatment with a rehabilitation period takes from 1.5 to 2 months.

Physiotherapy and exercise therapy

After treatment, a course of joint restoration begins. For the coronoid process this means:

Physiotherapeutic procedures.

Exercise therapy

Exercise therapy is an important part of treatment that helps restore joint mobility. If it is excluded and not carried out, joint contracture may occur, when after the end of treatment the joint remains motionless. The exercises are performed already on the 2nd day of the cast under the supervision of a rehabilitation specialist.

Exercises are always individual and depend on the age of the patient and the severity of the fracture. The developed movements are intended for plaster-free areas.

The simplest exercise for a fracture of the coronoid process - placing your hand behind your head - helps relieve swelling and normalizes blood flow. On the 10th day after the plaster, the muscles are trained under the bandage. Next come flexion and extension at the elbow.

A set of therapeutic exercises is performed 4 times a day, with 10 approaches.

You can’t exercise actively right away; increasing the pace and loads is only gradual. The exercise therapy complex is selected individually, taking into account the severity of the fracture.

Exercise therapy is good to combine with physiotherapy: magnetotherapy, electrophoresis, UHF, mud therapy. If exercise therapy and physiotherapy are prescribed at the beginning of recovery, then massage is performed in the middle of rehabilitation and at the end.

In case of a fracture of the coronoid process, massage is strictly forbidden due to the risk of developing myositis ossificans. Even after recovery, it is better not to overload the joint, because in this case the process turns out to be very fragile.

First aid

The first thing to do is call an ambulance. Then the victim should be given an analgesic. The hand should be immobilized; for this, any available means can be used as splints: thick cardboard, plywood, board. A splint is placed on the elbow to immobilize the hand, wrist and shoulder joints. As a rule, for fixation the arm must be bent, but if this is painful, the limb is left in its original position and fixed. If left untreated, joint contracture develops.

Hand fixation

To fix a hand with a fracture of the coronoid process in the emergency room, plaster is not applied; only plaster splints, orthoses, splints, fixators and bandages can be used.

Tissue retainers can easily replace plaster casts, and they also provide tissue massage. An elbow brace is an external orthopedic device that protects the joint from injury.

Athletes are very fond of using the elbow bandage; it relieves the load on the joint and relieves pain. It can also be used for prevention, because it relieves stress on the joint during training. The bandage is very valuable for arthrosis in the elderly, it slows down the development of degenerative processes and speeds up recovery.

Prevention

When an arm is broken, the entire process of immobilization from the very beginning is important. He doesn't pick himself up on his own. All prescriptions of the doctor should be strictly followed.

Other pathologies of the elbow joint

These are arthritis, arthrosis and deforming arthrosis, osteoporosis, dysplasia.

Arthrosis develops in the joint, but as the process progresses, bone growths grow, which also cover adjacent bone tissues, for example, the same coronoid process. Osteoarthritis usually occurs after 45 years of age. The risk group includes women during menopause, athletes (tennis players) and people whose profession involves heavy loads on the elbow (for example, writers, musicians, professional drivers).

Causes of arthrosis of the elbow joint:

elbow injury that occurred at a young age;
metabolic disease;
rheumatism;
chronic infections of ENT organs;
heredity.

Symptoms of osteoarthritis of the elbow joint

The main symptoms include:

pain during movement and walking;
pain at rest in later stages;
crunching during movements from rubbing the bones against each other, it is accompanied by pain;
inactivity of the joint due to narrowing of the joint space, growth of spines and muscle spasm.

Often with elbow arthrosis, the so-called Thompson symptom is observed - the patient cannot hold the hand bent into a fist in a dorsal position. He quickly spreads his fingers. The elbow joint changes - osteophytes grow, the elbow swells.

Deforming arthrosis of the elbow joint accounts for 50% of all arthrosis of the elbow. The complaints are similar, the pain is constantly increasing.

Osteology in dogs

Dogs have the same 2 coronoid processes as humans - in the lower jaw and the elbow joint.

Elbow dysplasia (EDD) in dogs is an inherited disease in which there is an abnormal joint structure with improper articulation of the elbow. Such an irregular joint is subject to wear and tear, and signs of arthrosis develop faster. If left untreated, it progresses rapidly.

There is no diagnosis of dysplasia itself. This is the collective name for all anatomical pathologies that formed during embryogenesis and in the first months of life. Dysplasia means abnormal development of any tissues, organs and bones. With dysplastic processes in the elbow joint, there can be 4 types of disorders:

fragmentation (separation) of the olecranon process;
chipping of the coronoid process of the ulna;
osteochondritis dissecans;
discrepancy between the bones of the joint (discongruence).

Various joint pathologies have similar symptoms. That’s why it’s so important to seek help from specialists. The diagnosis can only be made by X-ray results.

When exposed to a sharp traumatic force, the bone in the elbow area is destroyed. Such injuries account for approximately 3.5% of the total number of skeletal bone fractures.

A fracture most often occurs from an unsuccessful fall on an outstretched arm bent at the elbow or from a blow to the appendix.

Sometimes, for any reason, a sharp contraction of the triceps brachii muscle can lead to disruption of the integrity of the protruding part of the bone tissue.

The structure of the elbow is quite complex; it consists of three main bones:

Brachial;
Elbow;
Ray.

Also in the elbow joint there are also muscles, ligaments, nerve endings and blood vessels. The human elbow moves only in two directions - it bends and extends, but the mechanism of movement is quite complex.

During a fracture, damage to the neurovascular bundle occurs, which can lead to very significant consequences. Often, after such an injury, surgical measures are prescribed, especially if hemarthrosis occurs.

Causes

During a fall, people instinctively put their arms forward, which places a large load on the elbow, causing a violation of the integrity of the bone. This is the most common cause, but fractures also occur as a result of:

in case of a strong blow to the joint area with a foreign object;
in case of road accidents and various accidents;
in athletes (when the main load is on the arms, as in tennis and volleyball);
when trying to catch a heavy object falling at high speed;
in case of accidents at work.

Children and older people are most susceptible to fractures of the elbow, since their bones and ligaments are quite fragile. People with osteoporosis are also at risk.

Fall on hand;
Direct blow to the elbow joint.

Types of injuries

The fracture can be open or closed. Regardless of the complexity of the structure of the elbow joint, their symptoms do not differ from those of other fractures:

a common type of injury is a closed fracture, in which the structure of the soft tissues is not disrupted and no wounds are formed;
an open type fracture, on the contrary, is characterized by wounds and damage to the skin by a bone fragment. The size of the affected surface depends on the severity of the injury;
comminuted, in terms of symptoms it is very similar to a closed fracture, but differs in the presence of fragments inside, which can be easily felt during palpation;
a displaced fracture of the ulna (Fig. b below) is characterized by a violation of the usual contours of the limb or an unnatural position and externally visible appearance of the elbow joint;
a crack is a violation of the structure of the bone surface and does not require long-term rehabilitation and treatment.

The easiest and safest injury is considered to be a crack or closed fracture of the ulna without displacement (Fig. a).

According to the direction of the damage contour, fractures are classified into:

transverse;
longitudinal;
helical;
oblique;
compression.

The most rarely encountered in medical practice is an isolated fracture, similar in symptoms to a transverse one without displacement. This occurs due to the close proximity to the radius, which delays and maintains the position of the resulting fragments.

For this fracture, conservative treatment is used with the mandatory use of a plaster cast, which reliably fixes the injured area.

The elbow injury is classified as a compound fracture. In case of a fracture of the ulnar and coronoid processes of the bone, surgical intervention is necessary, which is necessary and contributes to the restoration of motor functions of the limb.

A fracture in the upper part of the ulna complicated by dislocation is called a Monteggia fracture or a paraging fracture. It most often occurs due to direct impact or blow to the area of the ulna.

Based on the location of the source of injury, there are:

periarticular (metaphyseal) fractures;
fractures of the ulna inside the joint (epiphyseal), which lead to destruction of the ligaments, joint, capsule;
fractures in the middle section of the bone (diaphyseal);
olecranon injuries;
fractures of the coronoid processes of the ulna;
damage to the styloid process located in the vicinity of the hand.

Elbow fractures have many classifications. It can communicate with the external environment (open type) and not violate the integrity of soft tissues (closed type), intra-articular and periarticular, based on the location of the injury.

Damage can be complicated by displacement of elements of damaged tissue, fragmentation, formation of fragments and dislocation.

The complex structure of the elbow gives rise to a classification that is based on the type of damaged element:

olecranon fracture (approximately 0.8-1.5% of all cases);
fracture of the neck and/or head of the radius (if the victim does not have time to bend his arm during a fall and lands straight);
fracture of the coronoid process;
fracture of the condyles (humerus).

Intra-articular;
Periarticular.

Intra-articular fractures are:

With displacement of bone fragments;
No displacement of bone fragments.

Traumatic fractures of the elbow joint are divided into:

When a person is injured, one bone may break (approximately 53% of cases) or several bones at once, most often 2-3. In addition, combined damage to the elbow is possible in the form of a fracture, dislocation or polytrauma, when the victim has multiple injuries.

By localization:

Fracture of the olecranon;
Fracture of the epicondyles of the humerus;
Intra-articular fracture of one of the bones.

Classification of elbow joint fractures is carried out both according to general parameters and according to signs characteristic of damage to intra-articular elements.

By contact with the external environment:

Primary open;
Secondary open;
Closed.

Primary open fractures are characterized by damage to soft tissues caused by an external traumatic agent. In secondary open injuries, tissues are damaged by bone fragments. Closed fractures have no contact with the external environment.

By the presence of fragments:

Single fragmented;
Splintered;
Splinter-free.

In single-comminuted fractures, there is 1 bone fragment at the site of injury. Multifragmented injuries are characterized by the presence of many small bone elements.

Comminuted fractures can also include their crushed variety, when there is no clear fracture line. An X-ray image can reveal a huge number of tiny bone elements.

The most complete and successful classification is considered to be developed by the Swiss surgeon Kocher in 1886:

Group A. Fractures of the lower end of the humerus:

Group B. Fractures of the upper end of the forearm:

coronoid process;
Olecranon;
Radial heads;
Radial necks.

Displaced fracture of the ulna

Displacement of bone fragments most often occurs with fractures of the olecranon. Significant displacement of the proximal bone is accompanied by damage to the triceps tendon and dislocation of the head of the radial bone - Malgenya injury.

While maintaining the integrity of the tendon, the fragments are displaced slightly, which sometimes makes it possible to do without their surgical comparison.

Displaced elbow fractures lead to complete loss of function of the limb; it hangs freely along the body. Attempts to bend the arm provoke a sharp outbreak of pain. Passive flexion is maintained, but is also accompanied by pain.

Usually the damage is localized in the area of the process of the ulna, since there are no muscles there to protect it. You may also encounter other types of fractures:

damage to the head or neck of the beam;
trauma of the coronoid process;
fracture of the humeral condyles.

In addition, the injury can be open or closed, and also located inside the joint capsule or outside it. Bone fragments may move from their places or remain in an anatomical position.

Most often, you encounter a closed type of injury, during which the bones do not injure nearby soft tissues. In open trauma, the skin is damaged when bone fragments break through it.

Symptoms

When examining the patient, the following signs are revealed:

The damaged joint is deformed and there is swelling.

Movement in this place is limited (extension does not occur completely).

There is bleeding visible under the skin in the joint.

When palpating the appendix, the injured person 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.

To correctly diagnose an injury, it is enough to pay attention to the characteristic symptoms of a broken ulna:

swelling in the elbow;
partial immobilization of the elbow joint;
the appearance of a hematoma at the site of injury;
severe pain throughout the entire limb.

If damage to the bone and joint does occur, this will be indicated by severe pain that radiates to the wrists and fingers. Other symptoms that may indicate an elbow fracture include:

pronounced edematous processes, sometimes with changes in the color and structure of the skin;
change in the shape and size of the joint (deformation and enlargement);
blocking motor activity in the shoulder joint;
lack of pulse in the injured hand, cooling of the fingers (slight, but more than usual);
loss of sensation or tingling in a limb;

There are signs indicating a specific type of fracture:

To diagnose a fracture, the X-ray method is used. But if the injury has one or more complications, the doctor may order a computed tomography scan to make an accurate diagnosis and identify the clinical picture.

Intra-articular fractures of the elbow lead to the following symptoms:

If the anatomical position of the fragments is preserved and there is no displacement, the function of the limb can be partially preserved. In this case, any flexion or extension movements in the elbow joint are extremely painful.

The position of the injured arm is often forced. In some cases, palpation can be used to feel the fracture line.

Signs of a fracture will vary depending on what part of the elbow joint is affected by the injury.

Diagnostics

There is pain when palpating the process. If a displaced fracture occurs, you can feel a void between the fragments.

When trying to bend the arm in the damaged area, pain is felt, which intensifies at the moment of straightening. With no offset, there is a little more freedom of movement.

An X-ray examination is carried out to determine the extent of the damage. Moreover, they do it 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.

It should be noted that in some patients, bone formations and sesamoid (impermanent) bones are possible in the damaged area, and the epiphyseal cartilaginous plate occurs only in children and young people under 20 years of age.

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Diagnosis of elbow fractures is made based on the results of examination of the victim. However, to confirm the diagnosis, one of the following types of x-ray examination is mandatory:

As a rule, ordinary radiography is sufficient for a final diagnosis.

Expensive examination methods are used only for complex fractures, when the doctor needs to obtain a three-dimensional image of the damaged area and determine the degree of damage to the surrounding soft tissue.

Treatment

Applying plaster

In case of a non-displaced process fracture, conservative treatment is prescribed. A plaster bandage is applied to the site of injury, which covers the third part of the shoulder (upper) together with the forearm (up to the wrist joint). The arm is bent at an angle of approximately 1200 and fixed this way.

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 the fragments are severely displaced, surgery is required. It is used if there is a distance of 2 mm or more between the 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. The operation can be performed as soon as the patient is admitted to the department.

After anesthesia, an incision is made over the damaged area. All blood clots and very small bone particles are removed through it.

The fragments are adjusted relative to each other in the correct position using a single-tooth hook. Using a drill, two knitting needles are inserted.

At a distance of at least 3 cm from the fracture, holes are drilled for pulling the wire holding the fragments together. The ends of the wire are twisted with pliers.

No more than 2 cm of the length of the needles is left above the olecranon, the rest is bitten off. The ends are bent towards the bone.

The operated limb is secured with a scarf. After about 5 days, it is recommended to start moving your arm. Complete rehabilitation of motor ability occurs within 5 weeks.

Metal fasteners are removed under local anesthesia no earlier than after 3 months.

For fractures in which a Monteggia lesion is present, osteosynthesis is performed using a long pin. The head of the radius is pre-set.

In case of fragmentation of the olecranon process and separation of its apex, all fragments are removed, and the tendon stretch of the biceps is fixed. They are secured using sutures in the area of the ulna, in which holes are drilled specifically for this purpose.

Fixing sutures are also made on the fascia and periosteum. After the operation, the arm is fixed for 3 weeks at an angle of approximately 1550.

Then comes the recovery period.

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Often, elbow fractures are combined with dislocation or displacement. This requires timely assistance from a specialist to increase the chance of resuming the normal functioning of the injured limb.

Treatment for a non-displaced elbow fracture involves immobilizing the limb for six weeks. To do this, a plaster cast is applied, which blocks the movement of the wrist and elbow joints.
A displaced fracture is treated surgically. The chipped part of the bone is fixed in an anatomically correct position using knitting needles and wire structures. After surgical correction, the patient must walk in a cast for about six weeks. The needles are removed only three months after the operation.
For fractures of the neck and head, a plaster cast is applied for three weeks. The displacement is corrected conservatively and surgically. If it is not possible to set the splinter fragment, an operation is performed during which the bone fragment is excised.
Damage to the coronoid process requires immobilization of the limb for a period of 4 weeks.

Medical tactics directly depend on the degree of violation of the relationship of the internal structures of the elbow joint.

Basic principles of treatment for an elbow fracture:

Accurate reposition of bone fragments and fragments;
Strong fixation;
Early function (active movements in the elbow joint).

Immediately after the fracture, it is necessary to ensure the immobility of the injured upper limb (immobilization). The scalene splint is applied to the arm from the upper third of the shoulder and reaches the heads of the metacarpal bones.

The injured arm is in a position of flexion at the elbow joint of 90-100 degrees. After this, the victim must be hospitalized in the trauma department of the hospital.

For intra-articular fractures without displacement of bone fragments, the victim is given a plaster cast for 2-3 weeks. It starts from the heads of the metacarpal bones and reaches the upper third of the humerus.

The injured elbow joint should be fixed at an angle of 90 - 100 degrees, and the patient's forearm should be in the middle position. To avoid the subsequent development of myositis ossificans, it is necessary to refrain from massage in the elbow area.

If a victim has a fracture of the lower part of the humerus, bone fragments have been displaced, then the doctor must compare them - reposition them.

For intra-articular fractures, this is very important, since displaced bone fragments can lead to deformation of the elbow and limitation of motor functions in the elbow joint.

One of the features of the treatment of intra-articular fractures is that it is necessary to stop therapeutic immobilization of the broken elbow joint as soon as possible.

If the doctor was unable to compare the bone fragments conservatively, then surgical treatment is indicated for the patient. During the operation, the traumatologist can accurately compare all the bone fragments and fix them with bolts and screws.

If a victim has a crushed or comminuted fracture as a result of an injury, then the bone fragments must be fixed using extrafocal hardware osteosynthesis.

Surgical treatment for a fracture of the olecranon is indicated if the diastasis between the bone fragments is more than two or three centimeters, and it manifests itself when the elbow is bent at an angle of up to 100 degrees.

In case of a fracture in the area of the head and neck of the radius without displacement of bone fragments, the patient is given an external plaster splint for 7-10 days. After removing the plaster, the patient is prescribed dosed movements in the elbow joint, as well as various physiotherapy procedures (paraffin baths, Sollux).

The load on the elbow should be moderate, only with the permission of the attending physician. As a rule, after 3-4 weeks the physiological function of the elbow joint is almost completely restored.

If the victim has a crushed fracture of the head and neck of the radius or a fracture with significant displacement of bone fragments that impairs the rotational mobility of the elbow joint, then the doctor must perform a resection of the head of the radius.

In case of a fracture in the area of the coronoid process of the ulna, the victim is given a circular plaster cast from the upper third of the shoulder to the heads of the metacarpal bones for three weeks.

After the immobilizing bandage is removed, the patient must undergo a course of rehabilitation treatment. If the fracture of the coronoid process of the ulna does not heal for a long time and the bone fragment is located in the elbow joint, then surgical treatment is indicated for the patient.

In severe cases, the patient has the head of the bone removed and an endoprosthesis installed.

Patients' ability to work is usually restored within 5-8 weeks after injury.

Non-displaced elbow fractures are treated conservatively. In this case, a deep plaster splint is applied to the back of the limb, starting from the upper third of the shoulder and ending in the area of the wrist joint.

The same is done for small displacements, if reposition was achieved by straightening the joint. The splint is applied for up to 4 weeks.

In this case, temporary removal of the immobilizing bandage for exercise therapy is allowed at the end of the 2nd week of treatment. After classes, the splint is returned to its place.

For displaced elbow peleloma, surgery is necessary. Osteosynthesis for comminuted fractures and significant displacement of fragments is carried out using the “tightening loop” method. In this case, channels are made in the fragments, through which the doctor pulls a special wire.

The resulting loop has an eight-shaped shape. The wire is tightened on the outer surface of the bone, firmly fixing the fragments in the required position.

Osteosynthesis using a “tightening loop” is good because it does not require long-term immobilization of the limb.

The postoperative suture is covered with an aseptic bandage, and the arm is suspended on a “scarf.” Active movements in the elbow joint are allowed already on the 3rd day after the intervention.

Full range of motion is restored on average within a month. It is necessary to remove the fixing structures after 3-4 months, after complete fusion of the bone.

For fractures of the elbow joint, the following drug therapy is used:

Painkillers and anti-inflammatory drugs

The use of painkillers is especially important in the first days after injury. Patients are prescribed drugs such as analgin, ketorol, ketorolac, ibuprufen, baralgin.

They help reduce pain intensity, swelling and inflammation. For very severe pain, narcotic analgesics can be used.

Antibacterial agents are indicated in 100% of cases of open fractures and fractures whose treatment required surgery. Closed fractures without displacement, which are treated conservatively, require antibiotics only in cases of severe inflammation.

Antitetanus serum

In case of open fractures and the wound is contaminated with soil, a tetanus vaccination is mandatory for all victims.

Open injuries, as well as surgical intervention, require the patient to be prescribed hemostatic agents (aminocaproic acid, vikasol, etamsylate). This reduces the risk of postoperative complications, prevents the re-development of hemarthrosis, and prevents the increase of hematoma at the site of bone damage.

Calcium supplements, multivitamin complexes, vitamin D₃

All these drugs allow you to speed up healing, improve the quality of bone connection, and restore limb function as quickly as possible.

Physiotherapy for fractures of the elbow joint is prescribed at the end of the 2nd week of treatment. In this case, the affected area is exposed to low-frequency and pulsed magnetic fields.

Magnetotherapy helps accelerate the regeneration of cartilage and bone tissue, improves blood microcirculation, prevents thrombosis, reduces swelling and reduces the intensity of the inflammatory process.

It is important to remember that prescribing magnetic therapy too early increases the risk of postoperative bleeding or bleeding into the joint from vessels damaged at the time of injury.

In addition, physiotherapy is not used in the presence of a pacemaker, malignant neoplasms, acute cardiovascular pathology and pregnancy.

After removing the plaster cast, the patient is prescribed ozokerite applications, heating, electropheresis with calcium preparations, salt baths, and mud therapy.

The treatment process must begin with diagnosis of the disease.

If there is a suspicion that the patient has a fracture of the ulna or other bone structures that form the elbow, then a thorough diagnosis must be carried out. To do this you will need to take an x-ray. In some cases, a computed tomography scan is performed.

Therapy and further rehabilitation are prescribed by the doctor based on the type of damage and the location of the fault line. A fracture of the elbow joint occurs in a variety of everyday situations or during sports activities.

A person may fall on their elbow or be hit on the arm with a heavy object during a fight. One way or another, the victim needs qualified treatment, so he needs to be given first aid and taken to the nearest hospital.

After the patient is admitted to the hospital, he must undergo a series of diagnostic procedures, after which the doctor makes an accurate diagnosis. In addition to basic rehabilitation therapy, the victim is also prescribed painkillers, since this injury is characterized by a strong manifestation of pain.

Sometimes such damage can be so serious that immediate surgical treatment is prescribed. If the injury is not too severe, the bones heal quickly and the patient returns to his normal life.

To ensure that the recovery period takes as little time as possible, the victim is prescribed exercises to develop the elbow joint.

When a person receives such an injury, the arm does not extend for a long time, because it is fixed with a plaster cast or a special splint.

Due to immobilization, muscle and tendon tissue lose their functionality. A special set of exercises and other procedures helps speed up the recovery of the upper limb:.

physiotherapy;
massages;
various physiotherapeutic procedures.

Full recovery requires some time, because an elbow fracture is a serious injury. Working out the elbow joint after a fracture is not a pleasant process, because during exercises a person often experiences pain.

But in order for the arm to straighten again and fully perform its functions, it is necessary to adhere to the doctor’s recommendations and do everything he recommends.

First aid for a fractured ulna

First aid for a broken elbow consists of completely immobilizing the injured arm. In the absence of a specialized medical splint, the latter can be made from improvised materials: planks, fishing rods, flexible metal rods.

When applying a splint, the limb should be carefully bent at an angle of 90˚, with the palm turned towards the victim’s face. If an attempt to give the arm the required position is accompanied by a sharp increase in pain, bending should be abandoned and the arm should be fixed in the position it assumed after the injury.

Before applying the splint to the body, wrap it with bandages, soft cloth, and gauze. It is not advisable to use unprotected metal or wooden elements, as they can cause additional damage.

The splint is applied in such a way that it immobilizes not only the elbow, but also the wrist and shoulder joints.

If there are no materials for making a splint, the arm can be suspended in a free position on a bandage of the “scarf” type. In this case, the victim must support the limb with his healthy hand to avoid excessive mobility.

For open fractures of the ulna, the wound along the edges must be treated with any antiseptic and bandaged with a sterile bandage. It is not advisable to apply cotton wool to open wounds, as this will subsequently complicate the initial surgical treatment.

Consequences

Incorrectly or poorly healed fractures can cause impaired motor function. If the therapeutic rehabilitation complex does not help restore functions, then surgical treatment is also used.

Through a longitudinal incision, all fragments are returned to the correct position and fastened. If the process does not fit into place well, then the tendon is fixed.

Old age is not an obstacle to performing operations on the olecranon. It is also possible to remove it and subsequently restore motor functions.

The patient’s recovery, the healing of damaged bone tissue, and subsequently the quality of his life largely depend on the qualifications and experience of the doctor involved in the treatment of injury.

The upper limb is an important component of the human skeleton. Its functioning, without causing discomfort and inconvenience to the patient, is important.

Ignoring doctor's orders during the treatment process or refusing rehabilitation measures can negatively affect natural functions, lead to the patient's disability or partial loss, and limitations in fulfilling the role assigned to it.

Nutrition

After a fracture, you will have to eat in such a way as to replenish the microelements used by organisms as building material for the regeneration of bone tissue. Basic products should be protein and high in collagen.

Meat contains a lot of collagen, especially turkey and duck, salmon family fish, oysters and shrimp. It is useful to eat vegetables: cabbage of all varieties, tomatoes, sweet peppers, herbs and peas. Fruits rich in vitamin C will help the joint recover faster.

Healthy fats are a must. They can be found in eggs, nuts, flaxseed oil and pumpkin seed oil.

If the patient is overweight, you will have to go on a diet, since excess kilograms put pressure on the joints.

An elbow fracture (especially if children are victims of the situation) is a fairly complex injury that can lead to complications. But modern medicine can easily correct such damage, so for a successful recovery the patient only needs to follow the doctor’s recommendations.