Fracture of the forearm( ulnar and / or radius) - Causes, symptoms and treatment. MF.
The basis of the forearm is formed by two bones: the elbow and the radius. These bones are interconnected by an interosseous membrane. The proximal( closer to the trunk) end of the forearm forms the joint surface of the elbow joint. At the other end, the forearm, connecting with the brush, forms the wrist( carpal) joint. In fractures of the forearm, one of the bones or both bones can be damaged immediately.
Forearm bones
Symptoms of forearm fracture
• Fracture of the diaphysis( body) of both forearm bones in the upper, middle or lower third of the forearm. Fracture of both bones of the forearm is accompanied by sharp pain, marked by swelling and bruising at the site of the fracture. If the fracture with displacement, deformation and shortening of the forearm is observed. When making movements in the damaged arm, a crunch of fragments can be felt. Because of pain, movements in the elbow and wrist joints can be restricted. The rotational movements of the forearm around its axis( supination and pronation) are severely limited.
• Isolated fractures( solitary) of the body of the ulna or radius in the upper, middle and lower third. Fracture of one of the bones of the forearm manifests itself with the same symptoms, but with less severity. Displacement of fragments is observed less often. The intact bone prevents this.
• Fractures of one bone, accompanied by a dislocation of the articular end of the other. For example, a fracture of the ulnar bone body causes a dislocation of the radial head in the elbow joint, and fracture of the radial bone often leads to a dislocation of the radial head in the wrist joint, which is associated with a close connection of these bones. In case of displacement of fragments, a fracture of the ulnar or radius bone is accompanied, respectively, by dislocation of the articular end of the radial or ulnar bone.
• Fracture of radius in a typical place. This is the most commonly occurring fracture of the bones of the forearm, and the skeleton as a whole. With this fracture, the enlarged articular end of the radius is damaged, which, when combined with the brush, forms the wrist joint. For fracture of the radius in a typical place is characterized by a sharp pain in the wrist joint, the pain gives in the brush. Puffiness and bruising are expressed significantly and extend to the hand and fingers. With a fracture with displacement, there is a visible deformation in the region of the carpal joint, a crunch of fragments can be felt. Movement, with a fracture "in a typical place," will be severely restricted in the wrist joint and almost unaffected in the ulnar.
Fracture of radius in a typical place
Fractures of the forearm without displacement, before carrying out radiography, can be confused with bruises of the forearm and damage to the ligaments of the wrist joint.
Open fractures of any of the above areas are accompanied by bleeding, the presence of bone fragments in the wound and damage to the soft tissues of the hand.
First aid for fracture of the forearm
• Pain relief
For this, any anesthetic painkillers( analgin, ketorolac, nimesil, etc.) can be approached, alcohol should not be taken for this purpose, it can only exacerbate the trauma and complicate the patient's communicationwith the doctor.
• Immobilization of a damaged limb segment
Achieved by overlapping the forearm of the tire. The tire can be made from improvised means. The board, sticks or sticks are fixed on the forearm, with the help of a bandage. It is always necessary to fix the wrist joint, the elbow and shoulder joints should be immobilized and unloaded with the help of the "kerchief" bandage
• Overlapping of the bandage, if there is bleeding
Open fractures are accompanied by bleeding, which must be stopped or weakened during first aid. To do this, it is enough to apply a tight bandage bandage to the injury site. If the bleeding is strong enough and pulsating( arterial bleeding), you must apply a tourniquet to the limb, but no more than 1.5 hours.
Diagnosis of forearm fracture
For the diagnosis, radiographic examination is performed in two projections.
Treatment of bone fracture
fractures of the diaphysis( body) of both forearm bones, as well as isolated fractures of the diaphysis of the radial or ulnar bone without bias are treated by applying a cast band from the middle third of the shoulder to the heads of the metacarpal bones( "bones" on the wrist).If a fracture with displacement or is accompanied by a dislocation of the adjacent bone, then the fracture and dislocation are corrected, then applying a plaster bandage from the middle third of the shoulder. The total period of permanent gypsum immobilization of these fractures is 6-8 weeks. If it is impossible and unsuccessful to reinforce the fracture, surgical intervention is performed with the fixation plates or rods. The cast plaster after the operation is superimposed for a period of 4 to 8 weeks, depending on the result of the operation.
If a radius fracture occurs in a typical place of , a gypsum is placed from the upper third of the forearm to the metacarpal heads so that the fingers remain free for movement. In case of displacement, the fracture is corrected and a similar dressing is applied for up to 6 weeks. If the fracture fails successfully, a fixing plate is inserted.
After removal of gypsum, they begin active rehabilitation of the patient. Plates and rods are removed in a period of 6 months to 1.5 years.
Rehabilitation for fracture of the forearm
For rehabilitation of patients with fractures of the forearm, physiotherapy, exercise therapy and massage are used. At home, warm baths with sea salt are used to relieve inflammation and more efficient development of movements - for 15-20 minutes three times a day.
Physiotherapeutic treatment uses magneto-laser therapy, UHF, electrophoresis, mud and paraffin applications.
Physiotherapy exercises for fractures of the forearm
3-4 days after the help and the casting of gypsum begin active movements in the fingers of the broken arm.
After 10 days, voluntary tension and training of the muscles under the plaster bandage are allowed, the exercises should be repeated several times a day.
After removal of gypsum proceed to develop movements in wrist( wrist) and elbow joints, if the latter was immobilized during immobilization. It is also necessary to develop rotational movements of the forearm( supination and pronation).
Exercises for the development of the elbow joint:
- In the sitting position at the table, under the fingers we take a children's typewriter and perform "rolling" movements on the table, elbow joint, while moving the toy on the table, unbent and bent;
- Playing with the ball in the standing and sitting position;
- We put our hands behind the head, the brushes are closed in the lock and stretch, spreading the lock with the palms to the top;
- After 2-3 weeks after removal of gypsum, we use dumbbells with a small weight( up to 2 kg.), Making flexion-extensor movements in the elbow joint.
All exercises for the development of the elbow joint are performed only in conjunction with a healthy side. Exercise 3-4 times a day for 10-15 repetitions.
Exercises for the development of the wrist joint( most often you have to develop with a fracture of the radius in a "typical place"):
- Exercises with a wrist expander. These exercises will improve blood supply in the joint and contribute to the development of the muscles of the hand and forearm;
- Unscrew and tighten the stopper on the bottle, make a healthy and sick hand alternately;
- Roll out the fictional dough with a rolling pin;
- Circular movements in the wrist joint, for this we take a round object in the wrist;
- Drawing aside the thumb and little finger;
- Flexion and extension in the wrist joint, creating an elastic resistance( fit a fixed rubber hose or bicycle camera).
Part of the exercises for developing the wrist joint are performed in a bath with sea salt, which will improve the result. We start with 10 exercises at a time, gradually increasing the amount. Repeat 3-4 times a day.
Be sure to perform rotational movements of the forearm. We do these movements, for example, when screwing or screwing a screwdriver.
Massage should be performed on the muscles of the shoulder and back, it will greatly improve the blood supply to the damaged arm. And only 3-4 weeks after the removal of gypsum and the withdrawal of inflammation, we proceed to careful massage of the injured forearm and developed joints, for 10-15 sessions per area.
When carrying out rehabilitation measures, it should not be possible to raise the severity of more than 3 kilograms, to bring the hand to considerable fatigue and severe pain.
Forecast for fracture of the forearm
As a rule, the prognosis for fractures of the forearm bones is favorable, the general terms of treatment reach 3 months, with a fracture of the body of the forearm bones, and 2 months, with fracture of the radius in a typical place. Only open and complicated fractures are treated for a longer time.
Doctor traumatologist Voronovich NA