Permissible displacement for a fracture of the ulna. Types of ulna fractures and their treatment. Treatment methods for ulna fracture

An elbow joint fracture is a complex injury that is diagnosed in 20% of fracture cases. It is known about the elbow joint that it consists of 3 bone fragments, namely the humerus, radius and ulna. Inside the joint there are articular joints that are connected to each other by ligaments and muscles.

The anatomy and physiology of the elbow joint is quite complex, so the injury that occurs when the elbow is fractured is considered dangerous. As a result of such an injury, many irreversible complications arise. As for how long it takes for a fracture of the elbow joint to heal, it must be said that it takes a very long time and, as a rule, a conservative treatment method is rarely used here, due to its ineffectiveness.

The elbow joint, in its anterior part, consists of the following bone fragments:

• Humerus.
• Ulna.
• Radial bone.

On the back of the joint are located:

• Brachial bone.
• Olecranon process.
• Elbow bone. Coronoid process.

Based on these anatomical features, injury can occur in any part of the joint. In this regard, symptoms, diagnosis and treatment will differ.

Classification

Fractures that are diagnosed in victims are divided into several types by experts. According to the place where the injury occurred, according to the nature of the damage. There are other classifications. More on this later.

Depending on the location, damage can be classified:

Fracture of the olecranon

One of the components of the elbow joint is the olecranon process. Damage to the appendix often occurs when a person falls on their elbow from a height. In this case, a fracture of the olecranon is identified with displacement in its upper part. As a rule, such an injury entails an extra-articular injury. The fracture takes a long time to heal, as a result of the fact that the triceps tendon is attached to the area itself; it, in turn, pulls the broken fragments towards the shoulder, which creates a diastasis between the fragments.

Fracture of the coronoid process

With a fracture of the coronoid process, the symptoms and nature of the damage are different. For example, isolated injuries of the coronoid process are a rare occurrence. Typically, a fracture results in a posterior dislocation or complex injury within the joint.

Due to the anatomical features, injuries to the coronoid process are extremely rare. Because this bone fragment is located as deep as possible under a thick layer of soft tissue. And as a rule, the fracture occurs at the base or at the very top of the process. Comminuted fractures of the coronoid process almost never occur.

Ulna shaft fracture

When the diaphysis is fractured, the injury is divided into 3 groups. The first group includes undisplaced fractures. To the second - . The third group of diaphysis fractures includes fractures with displacement of the proximal third, which is combined with subluxation or. The third type of fracture in medicine is called a Monteggia fracture.

Intra-articular fracture

The injury occurs inside the joint.

Extra-articular fracture

The damage occurs outside the joint.

Metaphyseal fractures

The injury occurs near the joint.

In addition to this classification, it is customary to distinguish:

• Closed fractures- the most common. When they occur, injuries to the skin do not occur; the damage itself can be identified by secondary signs, such as pain, swelling, and limited movements.

• Open– accompanied by damage to the skin.
• Splintered– when injured, there is a feeling of bone fragmentation. This type of fracture can be diagnosed using an image that will show the number of fragments and their location.
• With offset– palpation shows visible displacement of the bone.
• No offset when there is a crack - the easiest type of fracture. The healing process occurs faster than with other injuries.

Trauma code according to ICD 10

Fracture of the ulna, ICD10 code

Causes

A fracture of the olecranon, as mentioned above, occurs as a result of a fall from a height when the victim’s arm was slightly extended. Very often, for example, this happens precisely when the process is fractured with displacement.

When the coronoid process of the ulna is fractured, they speak of an indirect injury, which occurs as a result of a fall on the arm, in particular on the dorsum of the forearm, when its maximum flexion has occurred.

Fractures of the diaphysis occur due to the impact of a direct blow, which is also called a “bludgeon fracture.” Most often, this type of damage is diagnosed during an accident or fight.

In addition to the above-described causes of elbow injury, which are classified as a traumatic factor, there is also a pathology group in which fractures occur with minimal pressure on the bone. Most often, this happens when the patient has a calcium deficiency, or when he has diseases of the musculoskeletal system, for example, osteoporosis, arthrosis, osteoarthritis.

Symptoms

The symptoms of an elbow fracture are similar, but there are some differences. Since they depend on the location of the damage.

In case of a fracture of the olecranon process of the ulna, the signs of a fracture are characterized by acute pain and swelling of the joint itself. However, its limited action is noted. The elbow cannot be bent or straightened. Hemorrhage in the joint is also diagnosed. Pain may also be experienced when palpating the injury site.

When the coronoid process is fractured, the signs of damage are hardly noticeable and mildly expressed. There is often pain in the elbow and swelling at the injury site. Painful sensations can also occur when palpating the injured limb.

Clinical manifestations of a fracture

The symptoms of an elbow fracture are similar, but there are some differences. Because they depend on the location of the damage.

In case of a fracture of the olecranon process of the ulna, the signs of a fracture are characterized by acute pain and swelling of the joint itself. However, its limited action is noted. The elbow cannot be bent or straightened. Hemorrhage in the joint is also diagnosed. There may be pain when palpating the injury site.

In case of a fracture of the coronoid process, signs of injury are hardly noticeable and mildly expressed. There is often pain in the elbow and swelling at the injury site. Painful sensations may also occur when palpating the damaged area. hurts with passive movements. As a result of such symptoms, a conclusion is often made about intra-articular damage. And only with the help of x-rays can a correct diagnosis be made.

As a rule, the symptoms of an elbow fracture are not very different from each other; the difference can only be the degree of its severity.

First aid

A fracture of the elbow joint, if treated in a timely manner, heals faster and without any complications. If help is not provided in time, negative consequences may occur.

The first thing to do is call an ambulance. The victim is then given pain medication. They are trying to immobilize the limb for further transportation of the patient to the traumatology department. Complete immobilization consists of fixing the limb with a splint or wire loop. As a tire, you can use any available materials, for example, a piece of thick cardboard or plywood, or part of a board.

The splint must be applied in the area of ​​the elbow joint so as to immobilize the hand and shoulder joint. As a rule, fixation is carried out in a bent state at an angle. But this position can increase the pain. If the pain becomes stronger, the hand must be left in its original position and fixed.

Diagnostics

A fracture of the ulna, namely its olecranon process, is diagnosed using an x-ray. If the image revealed an intra-articular fracture of the elbow joint, additional research in the form of CT or MRI may be prescribed. X-ray examination is carried out in two projections. As a rule, this is enough.

With the help of CT, it is possible to detect to what extent the process has been damaged. After this, treatment tactics are determined. As for MRI, the study is necessary for complex fractures, as well as during surgery to compare the fragments.

Features of diagnostics of the coronoid process

Compared to other types of injuries, damage to the coronoid process may not be detected on anteroposterior and lateral films. Because to diagnose it, a forced position of the hand is necessary, which will remove the process from the zone of overlap of the shadow of the beam head.

To do this, the arm must be positioned so that the process and epicondyle of the humerus are in contact with the cassette. The forearm should be set in semi-pronation and in a flexion position at an angle of 160. The rays should be centered on the coronoid process. In this position, it is possible to diagnose a fragment of the coronoid process in almost 100% of cases. Since the process itself completely emerges from the shadow of the head of the radius.

Treatment

A fracture of the elbow joint without displacement, or with a slight (up to 5 mm) displacement, is compared using closed reduction without surgery. In all other cases, if displacement has occurred, treatment tactics are based on the location of the injury.

When treating a fracture of the elbow joint, particularly the coronoid process, reduction is rarely performed. Since all attempts to carry it out did not give the expected results. However, no significant shifts occur in this department. Treatment of a fracture of the coronoid process is carried out on an outpatient basis for 6–8 days, while the arm is fixed with a posterior plaster splint, with the forearm bent at an angle of 60–65 degrees. Then a complex of functional treatment is shown. As a rule, with such damage, working capacity returns within 5–6 days.

Interesting!

An article by one doctor told the story of how a 38-year-old woman came to him. She was diagnosed with a nonunion fracture of the coronoid process, and the injury was received 7 months ago and the pain was felt only when she extended her arm. During the survey, it was found that a fracture of this part of the bone was not detected at all. The doctor who examined her earlier diagnosed her with a bruise. At the same time, she was shown thermal procedures and therapeutic exercises immediately on the second day after the injury. Why did this happen and the diagnosis was not identified? This is due to the fact that the woman did not have severe pain, as a result of which she did not pay attention to it. Therefore, no one thought about additional research methods. Conclusion - it is always necessary to conduct a series of studies that will allow you to identify the injury immediately.

What happens if a fracture is not treated?

If the type of fracture in the victim is not diagnosed in time and timely therapy is not started, irreversible consequences will arise, the situation will be aggravated by contracture of the elbow joint after the fracture. Contracture of the elbow joint is a pathology in which pinching occurs when flexing and extending the arm. The reasons for this are different, but most often the condition is provoked by undiagnosed elbow fractures, inflammatory processes in the joint, various and degenerative tissue changes.

What is used to immobilize an elbow fracture?

To fix the damage, orthoses, bandages, plaster splints or bandages can be used. If the coronoid process is fractured, plaster cannot be applied. For this purpose, an orthosis is used.

If severe pain occurs, the use of painkillers is indicated.

Surgical treatment

Displaced fracture of the ulna, comminuted fracture, open fracture - conditions for which surgery is indicated. Typically, complex injuries of the elbow joint are subject to surgical treatment. If a person falls on his arm at a certain angle, a fracture of the styloid process of the ulna occurs. It is worth knowing that surgical intervention should be carried out in the first 24 hours after the fracture occurred.

During the operation, reposition is performed, then the bones are fixed using pins, bolts, and knitting needles. Sometimes they can perform osteosynthesis if necessary (sometimes they resort to performing osteosynthesis according to Weber, using knitting needles and tightening loops).

If the procedure is performed, bone fragments are removed, and an endoprosthesis is used instead of the epiphysis bone. If the fracture is open, with many displacements, and fragments have entered the joint, a periarticular plate is used. After the operation, the limb is also immobilized by placing a cast on the arm for 4–6 weeks.

How long to treat and wear a cast

An elbow fracture in many cases requires wearing a cast. But usually everyone is interested in how long you need to walk in a cast, and how long will the injury take to heal? The duration of wearing the cast, as well as the healing time, depends on a number of factors (age, illness, weight, lifestyle, etc.). Typically, the duration of wearing a cast is 1–2 weeks, 4–6 weeks. It all depends on the injury received and the nature of the assistance provided. The patient is on sick leave for the entire time he is in the cast. He is given a certificate of incapacity for work. In order for the bone fusion process to go faster, the doctor may prescribe.

Rehabilitation

An olecranon fracture is a complex injury, but if you approach its diagnosis, treatment and rehabilitation correctly, you will be able to completely restore the mobility of the limb. In case of a fracture of the coronoid process of the ulna, the recovery period should not exceed 6-7 days. Next, functional therapy begins. It is performed carefully and gradually.

Massage for this injury is strictly prohibited. This is worth paying attention to! Because there is a risk of myositis ossificans.

In the process of rehabilitation of the olecranon process, the following are indicated:

1. A set of exercises is recommended to be carried out in the first days after the injury has been sustained. At first, the exercises are done only with the fingers, since the muscles that are responsible for the movement of the fingers are located in the articular area from the epicondyles.
2. Next, under the supervision of a doctor, the arm is restored in the elbow joint after a fracture and surgery.

While the limb is in a cast, in the first stages of recovery, it will be difficult to straighten and bend the arm. But this must be done gradually, as soon as the doctor removes the plaster and allows rehabilitation after a fracture of the elbow joint.

It will be very difficult to immediately restore hand mobility, so you need to be patient. If these recommendations are neglected, arthrosis may develop.

Physiotherapy

For the purpose of rehabilitation, exercise therapy is performed after fractures of the elbow joint. But physical therapy is allowed only after consultation with a rehabilitation doctor, who will indicate the type of exercise and duration of treatment. Gymnastics and physical exercises after a fracture are usually performed at all stages of recovery. Electrophoresis, UHF, and magnetic resonance therapy can also be used.

Methods for elbow restoration after injury

The main goal of developing the elbow joint after a fracture is to restore its mobility and return to a normal lifestyle. Typically, after surgery, the recovery process takes longer. Therefore, you have to wear a plaster splint or orthosis for a long time (2-3 months). In this case, the arm muscles and tendons partially atrophy.

As for exercises to develop the elbow joint, they are necessary, but at the beginning of rehabilitation, pain and discomfort may occur at the site of the fracture.

If the ulna is fractured without displacement, the cast is removed more quickly. The rehabilitation process is not long.

Fracture restoration using exercise therapy is performed in 3 stages.

At the first stage

1. The patient is in a cast. In this case, the doctor recommends doing breathing exercises on the second day after the plaster was applied. It is also necessary to perform exercises on the part of the arm that is free and does not have a cast on it, that is, the area of ​​the shoulder and fingers.
2. Perform exercises that will help reduce swelling and normalize blood supply in the injured limb:

Place your hands behind your head on a pillow, sending impulses to the hand that is in a cast. Do not overexert your injured arm.

After removing the cast, you must slowly bend and straighten your elbow.

Second phase

1. The patient is sitting. The hand should be on the table. It’s great if the table is at the level of the armpit. This is followed by slow flexion and extension of the elbow.
2. The patient sits with his forearm resting on a high chair. You need to take a children's toy (ball, ball) in your hands. In this position, it is necessary to roll out the forearm area.
3. The patient is in a sitting position, but can also stand if it is more convenient. You need to take a small ball or stick in your hands. Using such objects, exercises are performed to develop the joint. In this case, the patient should not experience pain.
4. The patient is standing. The torso needs to be slightly tilted forward. In this case, you need to raise your arms slowly up, then lower them. Take your fingers into a “lock”, then raise them up and lower them behind your head, then return to the starting position.

Third stage

At the third stage, the above procedures are continued. Physiotherapy with paraffin applications is also included. The minimum number of procedures is 5 times. Exercises can be performed several times a day. If pain occurs, you need to consult a doctor and choose another treatment or reduce the load.

At the first stage, with any type of fracture of the elbow joint, massage cannot be done.

Massage

An elbow fracture is a complex injury. And the massage should be indicated by a specialist, since not all types of injury can be performed with massage. For example, if the coronoid process is fractured, massage is strictly prohibited. This can trigger the development of myositis ossificans. Therefore, it is better to consult your doctor about massage.

Complications

In case of a displaced fracture of the elbow joint, it is important to perform rehabilitation correctly, since improper physical activity leads to:

• to new injuries;
• to swelling in the area of ​​injury;
• to painful sensations in the elbow with radiation to the forearm;
• to reflex muscle contractions;
• to the growth of bone deformities of the elbow joint.

Fractures of the elbow joint lead to complications if assistance and treatment are carried out incorrectly. The rehabilitation process is very important, since if medical recommendations are violated, difficult-to-reversible consequences occur in the joint. In complicated cases, it is problematic to straighten the arm.

Prevention

In order to prevent a fracture of the olecranon without or with displacement, it is recommended to take care of your health and diagnose the problem in a timely manner. Remember, the entire rehabilitation process is important. You cannot choose a recovery course on your own. This can only be done by a doctor after studying the medical history. Next, you must follow all medical instructions. In such situations, it will be possible to avoid consequences and new injuries.

Dear readers of the 1MedHelp website, if you still have questions on this topic, we will be happy to answer them. Leave your reviews, comments, share stories of how you experienced a similar trauma and successfully dealt with the consequences! Your life experience may be useful to other readers.

The elbow joint has a rather complex structure. The presented part of the upper limbs is formed by the radius and is connected to the humeral tissue. Inside the main one there are several small ones. Large nerves and blood vessels, which are responsible for the mobility of the entire limb, pass through this area. Therefore, fractures of the bones of the elbow joint, in addition to difficulty in motor functions and the development of serious pain, are fraught with a whole host of complications.

What therapy is used for injuries of this type? How to treat fractures What is required for rehabilitation? We will try to answer the questions presented.

Causes of injuries

The elbow joint is extremely vulnerable to damage because there is no dense muscular frame that can provide reliable support and protection to the represented part of the upper limb. This area is especially often exposed to stress in children who are overly active and often find themselves in situations that can cause injury.

An elbow fracture can occur either as a result of a fall or as a result of a significant impact load on this area. Most often, damage to bone tissue here is internal.

Types of fractures

The following types of injuries to the bone tissue of the elbow joint are distinguished:

1. The elbow joint is characterized by damage to the radius, its neck and head. Most often it occurs as a result of excessive stress when leaning on a straight limb.
2. elbow joint - in addition to the occurrence of cracks in the bone structure, soft tissues are damaged by fragments. In severe cases, the skin ruptures, a gaping wound is formed, which is accompanied by heavy loss of blood.
3. A fracture occurs due to significant impact loads on bone tissue. Such injuries are quite rare. Injuries of this type are characterized by consequences in the form of displacement and dislocation of the forearm.

There are also fractures of the elbow joint with and without displacement. Often, with such injuries, one bone is affected.

Symptoms

The following signs may indicate an elbow fracture:

1. The presence of sharp, persistent pain that radiates to the hand and wrist.
2. Limited mobility of a limb or its complete paralysis.
3. Unhealthy, unusual for a person, mobility of the arm in the area of ​​the elbow joint, for example, in the lateral direction.
4. The occurrence of edema, the formation of a bluish hematoma, subcutaneous bruising.
5. Neurological symptoms - numbness of the fingers and hand, tingling of the forearm.
6. Damage to blood vessels, muscle tissue, and skin of the elbow joint).

A clear sign of something serious is severe pain in the back. Gradually, swelling and hematoma form on the anterior surface of the injured area. Subsequently, the ability to bend the arm is lost. The injured limb hangs limply. When performing movements with the forearm, muscle stiffness is felt.

After a fracture with displacement of the bone, the ability to straighten the arm remains. However, lifting the limb and rotating it to the sides causes significant discomfort.

First aid

First aid tactics for a fracture of the elbow joint are selected based on the specifics of the injury and its severity. Be that as it may, the primary task here is complete immobilization of the limb. To do this, it is recommended to resort to splinting. In this case, the arm is bent at a right angle, after which it is securely fixed. If it is necessary to eliminate unbearable pain, analgesics are used.

Conservative treatment

In the absence of open injury, conservative therapy is used. During the first 6-7 days after a fracture, swelling usually occurs. Until the pathological manifestation disappears, a splint plaster cast is applied to the arm. Avoid putting weight on the injured limb for up to 3 weeks.

As the bone tissue unites, the arm is periodically released from the cast to develop the joint. Over time, such a bandage is replaced with a rigid retainer, which has a system for adjusting the range of motion.

Operative therapy

Open fractures of the elbow joint, which are characterized by displacement of fragments, require surgery. Otherwise, the forearm's ability to flex may not be restored.

The success of surgical therapy directly depends on the accuracy of the trauma surgeon’s actions, in particular the comparison of bone fragments and their correct fixation in an anatomically correct position. The traumatology and orthopedics center is capable of performing such an operation.

For normal damage to the structure of the end of the ulna, therapy is aimed at tightening the tissue with a medical wire loop. Sometimes additional fixation of the bones in a static position with knitting needles is required.

If internal fractures of the elbow joint with the formation of fragments have to be treated, therapy is based on bone grafting. In such situations, it is difficult to tighten the tissue with a loop, since this can lead to shortening of the articular surfaces. Instead, they resort to the use of dynamic compression plates.

In cases where there are signs of bone fragmentation, the traumatology and orthopedics center can offer the patient replacement of bodily tissue with a special prosthesis. Implants are made from plastic and metal. They are installed using bone cement.

Possible complications

A disappointing consequence of a fracture of the elbow joint can be a complete or partial loss of mobility of the limb. A prerequisite for this is the persistence of a feeling of discomfort or significant pain at the end of the course of therapy. You can avoid such manifestations by strictly following the recommendations of your doctor.

To prevent complications in children, in particular loss of limb functionality, treatment should be carried out under adult supervision. First of all, the injured arm must be completely at rest throughout the entire course of therapy. The child should not load the limb or perform sudden body movements. Such negligence can lead to a re-fracture.

Rehabilitation

Actions aimed at restoring healthy limb functionality involve:

• massage;
• therapeutic exercises;
• physiotherapeutic procedures.

Development of the joint with the help of physical therapy is possible already on the first day after fixing the limb with a plaster cast. Naturally, in this case, bending the arm at the elbow is avoided. The main emphasis is on finger and wrist movement. The victim is recommended to place the injured limb behind his head while lying down, straining his shoulders. Such solutions help relieve swelling as a result of activating the outflow of lymph from the tissues.

When the joint's ability to flex is restored, it begins to gradually develop. To do this, the main part of the plaster cast is removed, after which measured, gentle movements of the limb are performed. During rehabilitation with the help of therapeutic exercises, it is forbidden to bend and straighten the arm completely, as this can cause a re-fracture.

Massage is resorted to only after the plaster cast has been completely removed. Moreover, the effect is exerted on the muscles of the shoulder girdle and back in a gentle manner. Regular implementation of such procedures allows you to eliminate pain, strengthen atrophied muscles, stretch ligaments and ultimately completely restore hand mobility.

As for physiotherapeutic procedures, it is recommended to alternate them with therapeutic exercises. Here they resort to UHF methods, magnetic therapy, electrophoresis, and healing mud treatment.

Finally

As a result, it is worth noting that the victim needs to clarify several questions for himself after being discharged from the hospital. You should check with your doctor about the best way to move the elbow joint, when you can load the limb with weight, how to avoid relapses and complications, what you can expect in the near future.

In traumatological practice, a fracture of the styloid process of the ulna is not uncommon. The injury is accompanied by pain, swelling, the appearance of a hematoma, and the mobility of the arm is limited. Damage is divided into types according to localization, as well as closed and open. After a fracture in the elbow joint, first aid should be immediately provided and the victim taken to a doctor who will prescribe effective treatment.

Types of fractures by location

Damage to the ulna has the following types:

• Intra-articular fracture of the process, in which the proximal part of the bone is injured.
• Injury to the epicondyle of the humerus, when the ligaments are stretched and torn off along with a fragment of the bone structure. This fracture is more common in children.
• A fracture of the head of the radial bone of the elbow joint is characterized by an impact of the neck of the radius on the humerus.
• Damage to the coronoid process resulting from dislocation.

Symptoms: how to recognize an injury

It can be closed or open, with or without displacement of bone fragments. Depending on the type of injury, the signs vary, as shown in the table:

How is first aid provided?

There are large nerves and blood vessels in the elbow area, so injury is dangerous due to innervation or deterioration of the blood supply to the hand.

An open or closed fracture of the ulnar shaft (middle third) or distal end requires immediate immobilization. The first aid algorithm is as follows:

1. Sit the victim so that the arm is bent at the elbow.
2. Apply a cold compress, first wrapping the ice in a cloth.
3. Apply fixing boards or a splint to the elbow joint, gripping the forearm.
4. Tie a tight bandage, making sure that it is not tightened too tightly.
5. Treat the wound if the integrity of the skin is damaged, being careful not to displace bone fragments.
6. Place your hand on the wide end of the scarf, tying the ends around your neck.
7. Give painkillers.
8. Take the victim to the hospital.

Diagnostics

A separation of the styloid process of the ulna and other parts of the joint is diagnosed by a traumatologist or orthopedist. The doctor listens to the history of the injury, conducts a visual examination, determines the type of fracture based on the nature of the pain, assesses the degree of limited mobility and prescribes x-rays. The method shows the details of the fracture, the condition of the nerves, blood vessels and muscles. Additionally, it is recommended to undergo arthroscopy, scintigraphy, ultrasound, CT and MRI procedures.

Treatment: what to do if you have a fractured ulna

Drug therapy

A plaster cast for a fracture is applied immediately after the injury. The timing of fusion depends on the complexity of the condition. Undisplaced closed injuries heal within 1-1.5 months, severe ones recover up to six months. In order for the fracture of the radius and ulna to heal correctly and quickly, it is recommended to take the following medications indicated in the table:

Surgical intervention

If an open fracture of the radial head with displacement is diagnosed, and there is also a section of the skeleton that has not healed correctly, surgery is recommended. During surgery, resection (removal) of dead tissue is performed, and a reinforcing plate or other metal synthetic items are installed in the upper or lower part of the bone. Then the doctor sutures, bandages with a sterile bandage and applies a fixative. During the period of wearing the cast, it is recommended to take control radiographs.

An ulna fracture is damage to the structure of the ulna as a result of trauma or mechanical force. This misfortune is quite rare and, as a rule, occurs as a result of an unsuccessful fall on the elbow.

This disease is not only extremely painful, but can also cause severe swelling and limit movement of the elbow joint. In order to protect yourself from complications and avoid surgery, treatment of the scourge must be done in a timely manner.

Varieties

Experts say that such disorders are most often found in people leading an active lifestyle and professional athletes. In addition, the risk of receiving such an injury is quite high in children (in the first years of life, the bones in the body are not fully formed) and the elderly (due to insufficient calcium content in the body and increased fragility).

In medicine, a fracture of the ulna is classified into several types:

1. lesion of the olecranon process. Most often it occurs due to a banal injury (fall on a limb, direct blow). This type of fracture can be transverse or oblique. In addition, the degree of displacement of the process may vary depending on the initial condition of the muscles;
2. Melgel's fracture. Its main characteristic is damage to the integrity of the process, accompanied by dislocation of the bones of the forearm. After such an injury, the position of the hand changes (becomes half-bent), and the palm itself turns forward. The deformed joint begins to increase in size and swell very much. Since this pathology is serious, it is treated not only by a traumatologist, but also by a neurosurgeon;
3. fracture of the head of the ulna (with and without displacement). Such an injury can be open or closed, but in any case the mobility of the joint will be significantly limited. From the side, the forearm will look a little shorter. If the fracture of the head of the joint is serious, the patient may be prescribed surgical treatment;
4. fracture of the elbow itself (distal third). One of the most common types of injuries. With this type of injury, the patient experiences severe pain, spreading to the entire forearm, and severe swelling and bruising are also observed;
5. fracture of the diaphysis of the ulna. The diaphysis is the center of the long bones. Since the radius bone is almost never damaged in this case, the damage usually resolves without displacement of the fragments. If the diaphysis is damaged, there is a possibility of severe deformation of the limb.

Such injuries usually occur in the upper region. It is quite difficult to get a fracture of the lower third, since the bones in this area are quite thick.

Fracture of the styloid process

A fracture of the styloid process of the ulna is a fairly common type of injury that is classified as seasonal. The largest number of such fractures occurs in winter, during icy conditions. Elbow fractures do not occur due to direct mechanical impact, but due to impact recoil.

Statistics show that women are much more susceptible to this pathology than men. If you receive a fracture of the ulna, the patient must immediately visit a doctor, as the injured area must be fixed. In order to avoid serious complications, before starting treatment, you need to examine the nerves and vessels of the limb.

Fracture of the coronoid process

This pathology is isolated and is extremely rare. A fracture of the coronoid process of the ulna most often occurs as a consequence of a posterior dislocation of the forearm. In most cases, with such damage, a tiny piece of bone will break off, and the displacement will also be insignificant.

The danger of this injury is that it practically does not make itself felt; the person will simply suffer from a dull aching pain. The clinical manifestation is very similar to a severe bruise.

Causes

Bone tissue is a connective tissue; it not only performs a supporting function, but also participates in blood flow and metabolism. More than half of every bone in the body is made up of minerals, but as we age, their amount begins to decrease, significantly increasing the risk of fractures. Factors that can cause a fracture of the ulna include:

• falling on a limb;
• a blow to the bone or a severe bruise;
• heavy objects falling onto a limb;
• presence of osteoporosis. This disease usually appears after age 50 and causes bone cell death. In some cases, it may be caused by prolonged use of certain medications.

Symptoms and signs

In order to avoid possible complications and improper healing, it is necessary to identify a fracture of the ulna at the initial stage. This injury is always accompanied by the following symptoms:

1. severe deformation of the damaged joint;
2. swelling of soft tissues;
3. the occurrence of painful sensations (especially when moving your arms);
4. visible bleeding under the skin;
5. if the fracture is displaced, the protruding part will become sunken;
6. restriction of hand movement;
7. numbness of fingers.

First aid

If you suspect an injury to the ulna, the first step is to completely immobilize the arm, this will reduce the likelihood of further displacement. If you don’t have a special medical splint at hand, an ordinary wooden board or metal rods will do as a last resort.

The splint should be applied so that the elbow is bent at an angle of 90 degrees (the palm should be turned towards the victim’s face). If, when trying to put the hand in the desired position, the patient experiences acute pain, this idea should be abandoned and the victim should be urgently taken to the hospital.

Treatment

Before choosing a treatment method, the doctor must diagnose the patient. It includes a visual examination, palpation, history taking and some instrumental examinations (X-ray, ultrasound). If a fracture of the ulna of the arm is confirmed and passes without displacement, treatment will be carried out using a conservative method.

The patient will be placed in a cast, which will need to be worn for 2 weeks to 4 months (depending on the type of injury). If the damage is accompanied by displacement, you will most likely have to resort to open reduction (through surgery).

In the rarest cases, doctors are able to remove debris without surgery, but this is only possible for simple fractures. In order to speed up the recovery process, the patient may also be prescribed certain medications:

• painkillers and anti-inflammatory drugs. They must be taken in the first few days after the immediate injury. Two types of analgesics can be used - narcotic and non-narcotic;
• antibiotics. Prescribed for any type of fracture, especially if the treatment was performed surgically;
• hemostatic agents;
• preparations with high calcium content and various multivitamin complexes.

Rehabilitation and recovery

After the ulna bone has fused, proper rehabilitation plays a very important role. Physical therapy, special massage, and physiotherapy will not only shorten recovery, but will also help to properly develop the arm. At the first stage of recovery, the patient is usually referred to exercise therapy; this can happen as early as 5 days after the injury.

Since the hand will be in a cast, the victim will only have to try to move his fingers and clench his hand into a fist. Over time, the exercise intensity and load will increase. For such injuries, therapeutic massage is also necessary. Most often it is carried out using the following techniques: pinching, straightening, squeezing, and turning the forearm.

How long does it take for bones to grow together?

If the patient strictly follows the doctor’s recommendations, does not remove the cast before the due date, and also does special exercises and attends physical procedures, the bone will completely recover in about 5-6 months (depending on the type of fracture).

The plaster itself can be removed in at least a month. More precise recovery times are determined by the attending physician individually for each person.

Consequences

A fracture of the ulna, if treated incorrectly or untimely, can lead to various complications. Doctors classify them into early and late.

The early ones include:

1. tetanus;
2. bleeding from a broken bone;
3. infection in the wound (bacteria can enter the body even during surgery);
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A fracture of the ulna is an injury, the essence of which is the destruction of the named bone by the influence of an external force on it (for example, a strong blow, the fall of a heavy object, or a collision with hard surfaces as a result of the victim’s body falling). At risk for this type of injury are people with high physical activity (athletes, people engaged in heavy physical labor), children (at this age a person tends to run and play outdoor games, which create an increased risk of falling or getting hit, and the bones are not yet fully formed and are more easily damaged than in adults), old people (older people have poorer footing and fall more often, and bone tissue in old age becomes fragile and can break even from a slight blow).

The ulna is an extremely important component of the musculoskeletal system, and its deformation relative to normal can significantly limit the ability to use the arm.

Therefore, in the event of an impact or fall that can lead to damage to the ulna, it is necessary to visit a traumatologist or surgeon as soon as possible. Only with timely, competent medical care is it possible to fully restore the functions of the hand.

The main symptoms by which doctors diagnose a fracture of the ulna are:

• severe pain throughout the injured arm, sharply intensifying upon palpation of the anterior surface of the ulna;
• the presence of a hematoma, as well as swelling at the site of injury, in case of severe damage - a visible change in the shape of the arm, protrusion of bone fragments from under the skin or from the wound in the case of an open fracture;
• impaired mobility of the elbow, any movements in the elbow joint cause severe pain and springy sensations or are completely impossible without outside help;
• unnatural mobility of the elbow joint, the possibility of directions of movement that are uncharacteristic for the elbow in normal condition;
• decreased sensitivity of the injured hand, numbness, impaired ability to move the fingers.

Types of ulna fractures

Based on the location of the fracture area, they are usually divided into:

• and the upper third of the bone located in close proximity to the joint - a dangerous injury, usually accompanied by damage to the joint and ligaments. Occurs, most often, as a result of a strong crushing blow to the elbow or an unsuccessful fall onto a bent elbow from the height of one’s body or more. Such a fracture can have a serious impact on the mobility of the elbow joint throughout life, especially if it is not treated promptly or incorrectly.
• Fracture of the middle (diaphyseal) part of the bone, tubular body. A relatively rare type among the general background of injuries to this area, it occurs exclusively as a result of an intentional blow. The most well-known type of such fracture is a Monteggia injury, or parry fracture, an injury caused by repelling with the hand a blow with a stick or other type of blunt bladed weapon directed towards the head.
• A fracture of the lower head of the ulna and the styloid process adjacent to the wrist joint is an injury that is of a pronounced seasonal nature, its peak occurs during the icy period, when people often fall, instinctively placing an outstretched hand to soften the blow. The main source of this injury in other seasons of the year is a fall from a bicycle, motorcycle, skateboard, roller skates, an unsuccessful acrobatic stunt that ends in a fall on a straight arm with force applied along its axis. Failure to see a doctor in a timely manner and insufficient medical care can lead to impaired mobility of the arm in the area of ​​the wrist and hand.

Diagnosis of ulnar bone injuries

As a rule, the initial conclusion about a fracture is made by a traumatologist as a result of examining the injured limb. However, in order to confirm the diagnosis, they must turn to one of the x-ray methods of examination.

In most cases, to obtain the necessary objective picture of the injury, simple radiography in two projections is sufficient. However, in the case of a serious injury with displacement, the presence of a large number of bone fragments, or a suspected fracture of the olecranon process with damage to the elbow joint, the prescription of more expensive methods, such as magnetic resonance imaging and computed tomography, which can provide a three-dimensional picture of the injury, is justified.

First aid

If you have a non-displaced or slightly displaced ulna fracture, it is important to immediately immobilize the injured arm. This is done using a splint made from improvised means (any flat boards, firmly fixed with a bandage, rope, scarf). If you have any painkiller at hand, you must give it to the victim, provided that he is conscious.

With an open fracture, it is extremely important to avoid infection of the wound and stop blood loss. For this purpose, the injury site is treated along the edges with alcohol or an antiseptic, and a sterile bandage is applied, and a tight tourniquet is applied above the wound to stop bleeding (it is important to record the time of application of the tourniquet. If you do not loosen it after an hour and a half, in the tissues above due to the lack of nutrition will begin to die off, and the arm will be lost).

Treatment methods for ulna fracture

A fracture of the middle part of the tubular body of the ulna without displacement is treated conservatively, by immobilization by applying a plaster cast. If there is a slight displacement, reposition of the bone fragments is carried out before casting; if with its help it was possible to achieve a normal position of the bone, surgical intervention is not performed.

In cases where there is a strong displacement - an intercondylar fracture of the upper head of the ulna, a fracture of the olecranon, especially with a fracture of the lower bone fragment, damage to the elbow joint with displacement, dislocation - surgical intervention is indicated. Also, surgery is always performed for an open fracture of the elbow joint.

A week after the initial medical intervention, an X-ray examination must be performed again to completely exclude the possibility of improper bone fusion.

Surgery

For serious injuries of the ulna and elbow joint, several types of surgical intervention are used; the choice of a specific type is determined by the specifics of the injury. Fragments of damaged bone can be fastened using plates or pins, a screw inserted into the bone canal, or wire or Mylar thread inserted into canals specially made in the fragments.

Immediately after the operation, a deep plaster splint is applied to the arm, after which the arm is fixed in a scarf sling at an angle of 60-90 degrees. The cast is worn until the bone fusion is complete (sometimes up to 3-4 months, for diabetes and other diseases in which bone fusion is impaired - more than six months).

Rehabilitation and prevention of ulna fractures

Rehabilitation measures used in recovery from an injury to the ulna can be divided into three large groups:

• Physiotherapy. The timing of restoration of full mobility of the injured limb depends on exercise therapy. Ignoring this component of rehabilitation can lead to the loss of part of the functionality of the hand. Exercises should be started as early as possible - 3-4 days after the fracture. For example, in case of a fracture of the olecranon process, it is necessary to begin developing the fingers in the first days after the injury, since the muscles that control the fingers are associated with the olecranon process.
• Physiotherapy. Physiotherapeutic procedures (UHF, microwave, electrophoresis) for fractures can have a healing and anti-inflammatory effect, stimulate muscles and nerve endings. Physiotherapy is recommended as early as possible for a fracture of the styloid process of the ulna. – s Here they are needed for the speedy restoration of nerves, often affected by this injury.
• Massage. It is necessary to improve blood circulation in affected tissues, as well as to maintain muscle tone while they cannot be sufficiently loaded.

A set of exercises for the rehabilitation of a fracture of the ulna

When the ulna is fractured, the load on the limb increases gradually. While the hand is in a cast, it is recommended to develop finger mobility and train the hand by clenching a fist (a little later - with an expander). Subsequently, exercises such as:

• games with a ball, ball, car on the table to develop hand motor skills;
• exercises with light (no more than 2 kg) dumbbells and weights;
• closing hands in a lock, raising hands closed in a lock.

Possible complications of ulna fractures

The most common complications observed after a fracture of the ulna are:

• Non-union or delayed bone fusion;
• malunion, secondary displacement of the bone under the cast;
• impaired joint mobility (elbow, wrist);
• rejection of implants (plates, pins, etc.);
• with an open fracture - infectious infection of the wound (the most dangerous infections are tetanus, sepsis);
• impaired sensitivity of nerve endings;
• thrombus and fat emboli (vascular blockages).

Fracture of the ulna in a child

As mentioned above, these fractures are more common in children than in adults. The specificity of an injury such as a fracture of the ulna in a child is that the child’s bones have not yet fully formed. Therefore, on the one hand, they grow together faster, on the other, they break more easily. The risk of malunion is significantly higher.

In addition, children, as a rule, are very mobile, so it is extremely important for adults to ensure that the child in the first days after receiving an injury does not show excessive activity with his hand, which can lead to displacement.