Fractures of the forearm divided into the following three groups. 1. Intra-articular fractures of the elbow: a) fracture of the olecranon, and b) fractures of the head and neck of the beam, c) fractures and detachments of the coronoid process ulnar bone. 2. Diaphyseal forearm fractures: a) fractures of both bones of the forearm, and b) an isolated fracture of the shaft of the ulna without dislocation and dislocation of the radial head, and c) an isolated fracture diaphysis of the radius without dislocation and dislocation of the head ulnar bone. 3. Fractures of the lower end of the radius: a) typical fracture epiphysis and epiphysiolysis discontinued and job styloid process of the ulna, and b) the lower metaphyseal fractures with a fracture and without fracture of the lower metaphysis of the ulna.
Fractures of the olecranon result from direct trauma (a blow, fall on solid ground), is less common gap top elbow, sprouts from the strong reduction of triceps brachii. Fracture line usually runs transversely across the bottom or the middle of the process, sometimes closer to the top, or move to the metaphysis of the ulna. Sometimes there is a comminuted fracture. When you break the triceps tendon is reducing its offset fragments in the proximal direction. Children may epiphysiolysis.
Diagnosis is based on clinical and radiological data. Damaged arm dangles, and the patient has to maintain its good arm. Quickly comes smoothing circuits elbow. Active flexion of the elbow sharply painful, but active extension is almost impossible. On palpation revealed local pain, diastasis (with displacement of bone fragments), fluctuation. The final diagnosis on the profile radiograph.
Treatment in the absence of bias is conservative: splint of plaster splint with a bent elbow for 2-3 weeks. If bending the elbow appears slight diastasis between the fragments, the tire is placed upon a straightened arm at the elbow (the testing X-ray). After 2 weeks of starting a gradual bending of the elbow, flexion angle achieved by fixing a new plaster tire. Upon termination of immobilization start gymnastics.
Treatment of fractures with displacement – only prompt. Admission or during the first two days after the injury stitched fragments with purse-string suture (cerclage) thick silk with a straightened elbow. For greater strength ulna drilling a channel through which is carried out, the silk thread. Simultaneously sewn triceps tendon injuries. Operation is better done through a longitudinal section of a length of 10 cm under local anesthesia. With a solid record sewing limb plaster splint at an angle 100 °, the tendency to shift the proximal fragment reduce flexing. Further treatment is the same as in fractures without displacement.
When comminuted fractures, especially in older people, it is better to remove debris and then suturing the tendon to stretch the triceps ulna. After the operation, the wound is sewn up tight and administered antibiotics. Children immobilization period may be reduced to 2 weeks.
Fractures of the coronoid process of the ulna often accompanied by posterior dislocation of forearm. There are also isolated damage from sharp decline inside shoulder muscles. The fracture is often not recognized. Recognition helps pain in the elbow during movement and tenderness. Diagnosis clarifies profile radiograph.
Treatment with small shift conservative. A plaster tire when bent at the elbow at an angle of 100 ° for 10-18 days. In some cases, high shift shows surgery – reduction and fixation with silk or catgut through an incision in the midline elbow. Gypsum Longuet impose for 3 weeks. Early movement and especially massage should not be used because of the risk of myositis ossificans.
- Fractures of the head and neck of the radius
- Diaphyseal fractures
- Isolated fracture ulna with dislocation of the radial head
- Diaphyseal fracture with dislocation of the radial head of ulna
- Open fractures of the diaphysis
- Fractures of the radius in a typical place
- Typical errors in the treatment of fractures of the forearm