Forearm and Elbow Fractures

Both Bone Forearm Fracture

As the name implies, a both bone forearm fracture is a fracture affecting both bones of the forearm - the ulna and the radius. These types of fractures often result from a direct blow, such as that sustained in a car accident, a fall from a distance, or a forceful object.

These types of fractures are generally displaced, which means that the broken parts of the bone are not aligned at the break and are no longer in their correct anatomical positions. Displaced forearm fractures in adults almost always require surgery, because the forearm is generally unstable and does not respond as well to casting as other bones.

Those suffering from this type of forearm fracture will experience 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.

Treatment
Following a physical examination and series of X-rays, a treatment and pain management plan is established. Depending on the severity of the breaks and extent of other tissue damage, the facture will be repaired with either closed or open reduction. Metal plates and screws may also be placed on both the radius and ulna bones in order to ensure proper alignment. All treatment is followed by a rehabilitative exercise program.

Distal Radius Fractures

Also called a Colles fracture, distal radius fractures are among the most common type of fractures, affecting the distal end of the radius bone in the forearm. It most often occurs when the arm is used to break a fall but may also occur as a result of a direct trauma or accident.

The radius, which is the forearm bone that runs between the wrist and the elbow, becomes rigid when it is extended to break a sudden fall. The extreme compression and twisting force results in a fracture at the wrist.

A fracture to the distal radius causes immediate pain, and there is an obvious deformity of the wrist. This may be followed by swelling, stiffness and loss of motion. Bruising may also be present.

Risk Factors
Distal radius fractures are most commonly seen in action sports athletes involved in such activities as motocross racing and cycling. They are also seen to a lesser extent in those involved in a trauma such as a car accident, as well as roller blade or skate boarding accidents. Distal radius fractures are also common in patients over the age of 60, as a result of osteoporosis. The decreased bone density of patients suffering from this condition increases risk of damage in even a minor fall.

Distal radius fractures are also common in patients over the age of 60, as a result of osteoporosis. The decreased bone density of patients suffering from this condition is vulnerable in even a minor fall.

Diagnosis and Treatment
A thorough examination and discussion of the manner in which the injury occurred is part of determining diagnosis. The appearance of the wrist is also a strong indicator of this type of fracture. An x-ray will confirm the diagnosis.

A fracture may be either displaced or nondisplaced. A displaced fracture means that the two bone parts are not in proper alignment. A nondisplaced fracture means that the bone, while fractured, remains aligned.

The treatment plan selected will depend on the severity of the fracture and whether it is displaced or nondisplaced. The primary goal in treating a fracture is to ensure that the bones heal in the correct alignment. Nondisplaced fractures may simply require bracing and anti-inflammatory medication. Displaced fractures may require surgery in order to ensure that the dislocated bones are replaced in their normal anatomic positions. This is called reduction. Reduction may be done either closed (no incision) or open (requiring an incision). The type of fixation used to hold the bone in the correct position is determined based on the condition of the patient, lifestyle, and severity of the injury. Fixation can be either internal or external.

Fractures of the Olecranon

Despite its strength, the vulnerable location of the olecranon - situated at the point of the elbow just below the skin - makes it among one of the more commonly fractured bones of the upper extremity.

Generally sustained from a fall on a semi-flexed forearm, an olecranon is fractured when the 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.

When an olecranon fracture occurs, the individual experiences intense pain, tenderness and swelling over the affected area, numbing in one or more fingers, visible bruising and possibly deformity.

These fractures are classified as, either Type I, II, or III fractures. 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
The classification of the fracture and severity of the injury will determine the type of treatment plan. Treatment may be either conservative, including immobilization and anti-inflammatory medication, or surgical. Generally only Type I fractures are treated nonsurgically with a splint or sling - securing the elbow at a 90 degree angle. The fracture is carefully monitored throughout the healing process, in order to ensure that it does not become displaced.

Surgical repair and internal fixation is generally indicated for Type II and Type III fractures. All surgery is followed by individualized physical therapy and range of motion exercises.

Fractures of the Radial Head

Radial head fractures most often occur when a fall onto an outstretched hand sends a force up the lower forearm bone to the elbow. Often times such a force will also break the smaller radius bone as well.

The radial head is among the most commonly broken elbow bones in adults, and fractures of the radial head account for nearly 30 percent of all elbow injuries.

Those suffering from a fracture of the radial head experience pain on the outside of the elbow and swelling in the elbow joint. It may also be difficult to bend or straighten the elbow, as well as turn the forearm palm up to palm down.

An important part of everyday elbow movement, the radial head is shaped like a round disc and moves in both flexion and extension within the elbow joint. 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 represent more than three broken pieces of bone that are displaced, or not in alignment.

Treatment
The type of treatment indicated will depend on type and severity of the fracture. It may be either conservative or surgical. Conservative treatment entails the use of a splint or sling followed by range of motion exercises. Surgical treatment would entail the removal of broken bone pieces and repair of any soft tissue damage. It may also utilize internal fixation, in order to ensure that the bones realign properly.