Forearm and Elbow Fractures and Dislocations

A both bone forearm fracture is the fracture of both bones of the forearm – the ulna and the radius. They most often occur as a result of direct trauma, such as a car accident a fall from a distance, or a forceful blow. There is pain, swelling and a visible deformity in the affected area. There is also the possibility of nerve damage resulting in paresthesia (burning or tingling skin sensation), or loss of function.

Most adult fractures of this kind are displaced fractures, which means that the broken parts of the bone are not aligned at the break and are no longer in their correct anatomical positions. These types of fractures in adults almost always require surgery, because the forearm is generally unstable and not conducive to casting.

Following a physical examination and series of X-rays, a treatment and pain management plan is developed.

Treatment
Depending on the severity of the breaks and presence of other tissue damage, treatment will consist of either closed or open reduction. Metal plates and screws may be placed on both the radius and ulna bones.

Despite its strength, the olecranon is frequently fractured in adults because of its prominent positioning directly under the skin on the point of the elbow – where most direct injuries to the elbow occur.

Most olecranon fractures are sustained from a fall on the semi-flexed forearm. During the fall muscles tense to break the fall and the strong triceps muscle snaps the olecranon over the lower end of the humerus. Olecranon fractures can range from simple nondisplaced fractures to complex fracture dislocations of the elbow joint.

Among some of the symptoms of an olecranon fracture include: intense pain, bruising around the elbow, tenderness and swelling over the affected area, numbing in one or more fingers, and possible deformity.

These fractures are classified as, either a Type I, II, or III fracture. A Type I fracture is usually stable with little displacement or malalignment, Type II fractures are among the most common and represent generally stable fractures with displacement, and Type III fractures are displaced and impact over 50 percent of the joint surface – resulting in joint instability.

Treatment
Depending on the type of fracture, treatment may be either conservative or surgical. Generally only Type I fractures are treated nonsurgically with a splint or sling – holding the elbow at a 90 degree angle. There is careful monitoring to ensure that the bones do not become displaced during the healing process.

Type II and Type III fractures are generally treated surgically with internal fixation. All surgery is followed by patient appropriate physical therapy and range of motion exercises.

Accounting for nearly 30 percent of elbow injuries, radial head fractures are among the most common broken elbow bones diagnosed in adults. It generally results when a fall onto an outstretched hand sends force traveling up the lower forearm bone to the elbow. Sometimes such a force will also break the smaller radius bone.

A fracture of the radial head prompts pain on the outside of the elbow and swelling in the elbow joint. Patients also experience difficulty in bending or straightening the elbow, as well as an inability to turn the forearm palm up to palm down.

Shaped like a round disc, the radial head moves in both flexion and extension within the elbow joint and is an important part of the elbow motion individuals are able to attain. So, injury to the radial head impacts all elbow movement.

These types of fractures are classified according to the degree of displacement, or malalignment. Type I fractures are usually small fissures with bone pieces remaining together. Type II fractures reveal slight displacement and involve a larger piece of bone. And Type III fractures reveal more than three broken pieces of bone that cannot be properly placed back together.

Treatment
Depending on the type of fracture, treatment may be conservative and involve the use of a splint or sling followed by range of motion exercises, or surgical to provide internal fixation, remove broken bits of bone and repair any soft tissue damage.