DAMAGE TO THE

ELBOW, FOREARM
AND HAND
Damage to the forearm
Forearm fractures are from 11.5 to 30.5% relative to the total number
of injuries and closed are heavy and difficult to damage.

Fracture of the olecranon

Such a fracture most often occurs as a result of a direct blow, at least -
a sharp reduction in the triceps muscle. Olecranon fracture with
transverse or oblique-transverse line can be held on any level in the
middle of crescent-cutting, at the bottom, at least in the apex. In the
majority of cases the fracture is intra-articular olecranon.
 Diagnostics.
• On examination, the elbow joint is determined by
swelling. The contours of the back surface of the joint
smoothed. Often the hand is in a forced position.
However, she straightened, hanging, fixed to the body
with his good hand. Passive motion maintained, but
painful. Active elbow flexion is possible, and active
extension of the forearm fracture with displacement is
impossible.

• Diagnosis is specified after elbow radiography in two

projections. A more informative picture on the side of
the projection.
 Treatment.
• Fractures of the olecranon without bias or diastase to 2 -
3 mm treated with immobilization back plaster splint on the
upper third of the shoulder to the metacarpophalangeal
joints for 3 - 4 weeks in the middle position between
pronation and supination and flexion of the forearm at the
elbow under the 90 - 110 °
• At the turn of the olecranon with the divergence of
fragments of 5 mm or more operative treatment:
osteosynthesis produce or remove fragmented process.
• In other cases, the operation comes to an end limb
immobilization with a plaster splint bent at right angles to
the forearm. Exercise therapy is performed on the first day
after surgery. Consolidation of fragments occurs within 4 -
6 weeks.
Fracture of the head and neck of the humerus
Fracture of the head and neck of the radius is the result of
indirect trauma at falling on outstretched arm, whereby the
head of the radius with great force strikes the capitate
shoulder elevation.

Diagnostics
When viewed from the cubital fossa is determined by swelling,
more pronounced over the projection brachioradialis joints. On
palpation revealed local tenderness, aggravated by movement.
Active movements restricted and painful (more limited
extension, is very painful rotation of the forearm outwards).
The radial head is not involved in pronation and supination.
The load of the axis of the bone is painful. Radiography in two
projections allows you to specify the diagnosis.
 Treatment
•For fractures of the head and neck of the radius
without bias or with a slight offset and tilt the
head up to 20 ° on the arm, bent at the elbow at
an angle of 90 - 100 °, for 2 - 3 weeks impose a
plaster splint from the metacarpophalangeal
joints to the middle of the shoulder. In this case
the forearm attach to the average between the
supination and pronation position. Employability
is restored in 7 to 8 weeks.
• When neck fractures with displacement and tilt of the
head of more than 20 ° is a single-step manual
repositioning. In the case of a failed reposition
fragments shows the operation: open reduction of the
radial head and transarticular fixing needle or pin bone.
If the head does not reduce a radius, it is removed. The
head is also subject to removal when comminuted
(crushed) turn and head fracture with displacement of
more than 1.3 parts of its joint. After operation for 10 -
15 days in a plaster splint is applied to the forearm
position, average between pronation and supination with
elbow flexion to 90 º. Then begin the gradual
development of joint movement. Employability is
restored in 1 - 2 months
 Isolated fracture of the ulna

Fractures of the diaphysis of the ulna

often occur under the influence of direct
trauma. When an isolated fracture of the
ulna bone fragments may move more
often in width. Isolated fracture of the
ulna can occur at any level, but usually
occurs in the distal her department.
 Diagnostics
On examination of the fracture revealed deformation and
swelling of the soft tissues. On palpation of the ulna are
determined by local tenderness at the fracture, rib
discontinuity ulna, abnormal mobility of the fragments.
The load on the axis of the forearm soreness in the area
of ​fracture. Brings together the load on the arm bone
(compression sides) leads to increased pain at the
fracture site. Active movements of flexion and extension
at the elbow, pronation and supination of the forearm
are possible on a small scale. Radiographs in two
projections with the capture of the wrist and elbow joints
make it possible to clarify the clinical diagnosis, to
determine the nature of the fracture and displacement of
bone fragments
 Treatment
When an isolated fracture of the ulna diaphysis without bias
or offset of fragments not more than half the diameter of the
bone impose a plaster cast from the base of the toes to the
upper third of the shoulder. The forearm, bent at the elbow
90 °, lockable in position, average between pronation and
supination. Immobilization was carried out for 12 - 14 weeks.
In those cases where a fractured ulna diaphyseal fragments
offset angle anteriorly and medially (towards the radius)
should be carefully reposition. Offset fragments can be
removed by manual repositioning, but it is better to take
advantage of this distraction device. After reposition impose a
plaster cast of the metacarpophalangeal joints to the upper
third of the shoulder. Immobilization of limbs lasts 12 - 14
weeks. Employability is restored after 16 - 18 weeks.
• Isolated fracture of the diaphysis of
the radius

Isolated fracture of diaphysis of radius is usually

caused by exposure to direct trauma. the
fracture line often located laterally. Fracture of
the radius can be located at any level, but the
most frequent location - on the border of the
bottom and middle, middle and upper third of
the forearm. Displacement of fragments
depends on the level of the fracture and the
action of muscles attach to the bones of the
forearm.
 Diagnostics
The radius is located deeper than the
elbow, so the integrity of the ulna
fracture isolated beam is often difficult to
recognize. On examination of the fracture
revealed deformation due to displacement
of bone fragments and swelling of the
soft tissues. On palpation of the radius is
determined by the local tenderness at the
fracture increasing with pressure.
 Treatment
Isolated fractures of the diaphysis of the radius in
the upper and middle thirds of the treated in a cast
from the base of the toes to the upper third of the
shoulder without displacement of fragments. The
forearm, bent at the elbow 90 °, lockable in the
position of supination. At the turn of the diaphysis of
the radius in the lower third of the plaster cast is
applied to the lower third of the shoulder. Forearm
thus fixed in position, average between pronation
and supination. Immobilization was carried out for 8
- 10 weeks. Employability is restored after 10 - 12
weeks. In cases where there is a fracture of the
diaphysis
 Fracture of both bones of the forearm

Diaphyseal forearm fractures account for 53% of

all fractures of the upper extremities and can
occur both in direct and indirect mechanism of
injury. Unlike fractures at other sites for
diaphyseal fractures of both bones of the
forearm bone fragments characteristic of
convergence radius and ulna, interosseous
membrane due to tension. This is offset, and the
difficulty of its removal largely determine the
choice of treatment
 Diagnostics
The patient gives a gentle hand position: the injured arm is
fixed to the body with his good hand. The degree of
deformation depends on the nature and the degree of
displacement of bone fragments. If there is displacement
of bone fragments damaged forearm shorter healthier. On
palpation determined soreness all over the forearm,
sharply increasing in the fracture area. Pain occurs when
the axial load and compression fracture of the forearm
away from (Bringing the load on the radius and ulna),
there is the mobility of bone fragments in the fracture, they
can crepitus. forearm function dramatically impaired. To
clarify the diagnosis and determine the nature of the
displacement of bone fragments need to produce X-ray in
two projections with the capture of the wrist and elbow
joints.
 Treatment

At the turn of the two forearm bones without

displacement of fragments impose circular plaster
bandage on head metacarpal bones to the middle of
the shoulder when bent to a right angle at the elbow
joint of the forearm. He was attached to a position
halfway between supination and pronation; Brush
placed in dorsiflexion position at an angle of 25 - 35 °
With 2 - 3rd day produce active movements of the
fingers and the shoulder joint. immobilization period 8
- 10 weeks, after which the prescribed dosage of
motion in the elbow joint and physical therapy.
Employability is restored after 10 - 12 weeks.
Osteosynthesis of forearm bones
 Ulna fracture with dislocation of the radial head

•If you fall to the ground, drawing on the hand, hitting a forearm
on a hard object during the fall, reflecting the impact stick lifted
forward and upward bent at an angle of 90 ° forearm between the
middle and the upper third or upper third of it there is a fracture of
the ulna, accompanied by dislocation of the head radius. Distinguish
flexor and extensor fractures of the ulna with dislocation of the
radial head.

•When flexion fracture of the head of the radius is displaced

anteriorly, and fragments of the ulna - backwards. It forms an
angle open anteriorly. Montedzhi flexion fracture is rare. When the
extensor type of head of radial bone after breaking the annular
ligament sprained backwards and outwards, fragments of the ulna
are displaced anteriorly, forming an angle open posteriorly.
fracture Montedzhi
 Fracture of the radius with dislocation of
the head of the ulna

In the fall of relying on the outstretched hand (but

more often when striking forearm) may occur
diaphysis of the radius fracture in the lower third and
dislocation of the head of the ulna. Radiation bone
breaks in the weakest spot (area of curvature).
Fragments radius displaced anteriorly, forming an
angle open posteriorly, and the head of the ulna in
the palm or the back side. Distal fragment apart
upward displacement under the influence of muscle
contraction in the position of pronation.
Displacement of fragments when
damaged Galeatsii
Treatment
Reposition fragments and reduction of the head of the ulna - a
difficult task for the trauma in connection with the existing
predisposition to recurrent dislocation of the head. After
repositioning the limb from the base of the toes to the upper third
of the shoulder impose a plaster cast for 8 - 10 weeks. When a
failed attempt to reposition the bone fragments and reposition the
head of the ulna surgical treatment. The goal of surgery is open
reduction and osteosynthesis of the radius, as well as open
reduction and holding the head of the ulna in the reduction
position. Complete casting of the operation from the base of the
toes to the upper third of the shoulder 8 -10 weeks. earning
capacity

Fractures and dislocations of the wrist bones

Damage any part of the brush to a greater or lesser extent affect its
function. Fractures of the bones of the hand up to 35% of all
fractures of the bones.
Fracture of the carpal bones.
These lesions are often diagnosed as a sprain. Improved
diagnostics causes an increase in the number of cases of
diagnosed fractures of the wrist bones. According to the
literature, the frequency of fractures of the wrist varies from
2.1 to 5% of brush fracture. The most common fractures of
the navicular bone, at least - lunate, and even rarer - the rest
of the bones of the wrist.

Fractures of the scaphoid. Such fractures may result from

falling on outstretched straightened brush, as well as the
direct impact on the palmar surface of her. In the fall of the
navicular bone is compressed between the beam and the
support surface, as if re unbent to the rear. Navicular usually
breaks in the tubercle, in the place of greatest narrowing of
the body of the navicular bone.
Fracture of the navicular
bone.
1.2 - at the turn of the
body fragments of the
scaphoid; 3 - tubercle
fracture.
Treatment.
Features of the blood supply to the scaphoid cause
unfavorable conditions for its fusion of bone
fragments. in the tubercle of the scaphoid fracture
treatment is to immobilize the wrist plaster cast for
3 - 6 weeks in the position of lead I finger -
"pistol" bandage.

The cast with a broken scaphoid

Dislocation of the lunate bone. Most often it occurs as a result of
the load on the brush, which is in the position of maximum
dorsiflexion. Lunate bones under the influence of radiation and capitate
bones squeezed out front. Thus there is a gap rear beam-lunate
ligament and ligaments connecting the lunate bones to other bones of
the wrist. Lunate bone can turn 90 °, and capitatum - set against
radiation.

Treatment.
To reposition dislocated lunate bone should begin immediately under
the wire, intraosseous anesthesia or, better, under anesthesia. When
you reposition a strong exercise and the gradual extension brush axis
with counter-traction on the shoulder with a bent 90 ° forearm. The
surgeon, without interrupting traction with both hands slowly produces
dorsiflexion brush. At the moment of maximum extension of the
surgeon I finger, feeling on top of the palm of the hand dislocated
lunate bone presses down on her, and the right hand at the moment
quickly translates the brush in position palmar flexion to 45 ° is often
accompanied by a reduction easy click.
Diaplasis lunate bone is characterized by the disappearance of the
protrusion of bone projection, unbending fingers, passive movements
to perform them in full. After this brush is fixed in position palmar
flexion circular plaster cast from the heads of metacarpal bones to the
upper third of the forearm. After 1 - 2 weeks the brush fix a new
plaster cast in the position of a light dorsiflexion. The total period of
immobilization of 3 - 4 weeks. Assign physical therapy and massage
the muscles of the forearm.
Fracture of the metacarpals

Fracture of the metacarpal bones - a very common injury. The most

common fracture of the base of I metacarpal bone, which is caused
by a direct blow to the base of the I metacarpal bone, falling I
finger rectified able to bring it, etc. There are two types of
fractures.:
• intra-articular (Bennett fracture or Roland)
• extra-articular (oblique and transverse).

If there is a fracture in the longitudinal palmar-ulnar edge of the

base of I metacarpal bone fragment in the form of a triangular
pyramid is held in place cords and metacarpal bone under the
influence of the long abductor muscle and extensor finger moves in
the proximal direction (Bennett's fracture-dislocation). Comminuted
fracture of the base of I metacarpal bone is known in the literature
under the name of Roland fracture.
Bennett fracture and fracture
Roland
Technique 1 reposition of fracture
metacarpal (Bennett) skeletal traction

Technique 1 open fracture reduction

metacarpal (Bennett).
 Treatment

For fractures of metacarpal bones without displacement

required plaster splint immobilization of the distal palmar
crease to the upper third of the forearm for 3 - 4 weeks.
Fractures repositioned in a large displacement under
local anesthesia by simultaneous pressure on the vertex
of the angle formed by the displacement of the
fragments, in palmar direction and metacarpal head in
the opposite direction along the traction axis. After
reposition fragments impose a plaster splint (the back or
palm) from the middle finger to the upper third of the
forearm. Immobilization is continued for 3 - 4 weeks,
after which the prescribed physical therapy, massage
and baths. Employability is restored after 4 - 6 weeks.
Fracture of the phalanges

Fracture of the phalanges often occurs due

to direct and, more rarely, indirect injury,
and requires close attention, as the
usefulness of the hand is determined by the
normal function of the fingers. Most often
under the influence of traumatic force and
the reduction of worm-like and intercostals
muscles occurs typical offset phalanx bone
fragments at an angle to each other, in an
open rear side.
Diagnostics

At the turn of the phalanges with displacement of

fragments marked deformity, shortening of the
fingers, a damaged finger diffuse swelling,
bruising. Palpation reveals the bony prominence on
the palmar surface, and local tenderness. The load
is along the axis of the finger is painful in the
fracture area. At the site of the fracture fragments
is determined by the mobility. Movement of the
finger is limited due to pain, especially extension.
Radiographs made in two projections, enable us to
determine the nature of the fracture and
displacement of bone fragments.
Treatment

Reposition of bone fragments is performed under local anesthesia

with 1% solution of novocaine (5-10 ml). At constant manual
traction on the axis of the finger pressure to the palmar surface of
the top of the angle formed by the fragments bumped, correct the
angular deformity. Plaster fixation, especially the oblique or
intraarticular fractures of the phalanges not always prevents
secondary displacement of fragments. When a failed one-stage
fracture reduction phalanges can use traction. If the reduction is at
diaphyseal fractures of the phalanges not achieved, it is advisable
to fix the fragments of fine needle, an injection needle or a bone
pin. After the operation is shown plaster immobilization for 4 - 5
weeks; spokes removed after 3 - 4 weeks. After removing the
plaster splints prescribed exercise therapy and physiotherapy.
Employability is restored after 6 - 8 weeks.
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