Broken arm is a violation of the integrity of one or more bones of the upper limb as a result of injury. Possible damage to the humerus, ulna and radius (isolated or simultaneous), wrist bones, metacarpal bones and hand bones. Clinical manifestations may vary significantly. Common signs are sharp pain, swelling, bruising and restricted movement. In some cases, shortening and deformation of the affected segment, bone crunch and pathological mobility are detected. To confirm the diagnosis, radiography is used, less often – CT and MRI. Treatment tactics and prognosis for a fractured arm depend on the type and nature of the injury.
ICD 10
S42 S52 S62
Meaning
Broken arm is one of the most common traumatic injuries. There may be a violation of the integrity of any segment of the upper limb, but the lower third of the radius is most often affected (a beam fracture in a typical place), the surgical neck of the shoulder, the phalanges of the fingers and the metacarpal bones. There is a definite relationship between the level of fracture and the age of the patient. Thus, fractures of the shoulder neck are more often detected in elderly people, fractures of the beam in a typical place – in children and elderly patients, fractures of the shoulder diaphysis, phalanges of fingers and metacarpal bones – in young and middle-aged patients.
The fracture of the arm can be isolated or multiple. Especially often there are multiple fractures of the metacarpal bones and phalanges of the fingers. In some cases, arm fractures are complicated by compression or nerve damage, especially often such complications are detected with fractures of the shoulder diaphysis and intraarticular fractures of the elbow joint. It is also possible to combine with other injuries: a fracture of the collarbone, shoulder blade, rib fractures, chest injury, pelvic fracture, lower extremities, TBI, bladder rupture, blunt abdominal trauma and kidney damage. Treatment of fractures of the hand is carried out by traumatologists.
Pathanatomy
The human arm includes three segments: shoulder, forearm and hand. The shoulder is formed by a single tubular bone (humerus), which consists of a hemispherical head, a neck (the border between the head and the diaphysis), a diaphysis and an expanded and flattened lower part ending in a block and a cephalic elevation. Above the elevation there are two tubercles – the lateral and medial condyles. The head of the humerus articulates with the articular cavity of the scapula, forming the shoulder joint, and its distal part connects with the block-shaped notch of the ulna and the head of the radius.
The proximal parts of the radius and ulna also articulate with each other. Thus, a complex elbow joint is formed, which includes the shoulder, shoulder and elbow joints enclosed in a common capsule. The forearm is formed by two tubular bones: the radius and the ulna. The radius is located on the side of the thumb, the ulna is located on the side of the little finger. In the upper (proximal) part, the ulna is thicker than the radius, in the lower – on the contrary. In the middle part, the bones have approximately equal thickness. In the lower part, the radius expands, and the ulna narrows. With its distal end, the radius articulates with the proximal row of wrist bones, forming the wrist joint.
The brush consists of 27 bones. In the proximal part of the hand there are 8 small spongy bones of the wrist, arranged in two rows (4 bones in each). 5 tubular metacarpal bones are attached to the distal row of wrist bones, and the tubular bones of the main phalanges of the fingers are attached to them. II-V fingers consist of three phalanges, I finger – of two. Unlike the rest of the metacarpal bones, the I metacarpal bone is connected to the bones of the wrist by means of a movable joint, which ensures the full functioning of the hand: the abduction and opposition of the thumb, the capture of objects, etc.
Classification
Depending on the cause of occurrence in traumatology and orthopedics, traumatic and pathological (non-traumatic) broken arm are distinguished. Traumatic broken arm are formed with intense traumatic impact on a bone with a normal structure. Pathological fractures occur in congenital and acquired pathological conditions accompanied by a violation of the structure and strength of bones, including osteoporosis, osteomyelitis, bone cyst, benign bone tumor, primary malignant bone tumor, metastasis to bone tumors of other localizations, hyperparathyroid osteodystrophy, genetically determined osteogenesis imperfecta and some other diseases.
All fractures of the hand are divided into open (with damage to the skin) and closed (without damage to the skin). If the integrity of the skin is violated at the time of injury, open broken are called primary open, if the skin is damaged by a bone fragment some time after the injury (for example, during transportation) – secondary open. Open fractures are usually complete, closed fractures of the arm can be complete or incomplete. With complete fractures, the integrity of the bone is completely violated. In case of incomplete damage, the bone breaks, but does not break completely (crack), or a small area breaks off from it (separation of bone tubercles, marginal fracture).
Taking into account the localization , the following broken arm are distinguished:
- Epiphyseal – the fracture line is located in the area of the epiphysis (end) of the bone. In most cases, these are intra-articular injuries.
- Metaphysical – the fracture line is localized in the intermediate zone between the end of the bone and the body of the bone. Such fractures are periarticular.
- Diaphyseal – the fracture line is located in the area of the bone body. Such injuries, in turn, are divided into fractures in the lower, middle and upper third.
Depending on the direction and nature of the fracture , there are several types of arm fractures:
- Transverse – the fracture line runs perpendicular to the bone.
- Longitudinal – the fracture line is located parallel to the bone.
- Helical – the fracture line resembles a spiral.
- Oblique – the fracture line runs at an angle to the bone.
- Comminuted – three or more fragments are formed.
- Fragmented – a large number of small fragments are formed.
There are broken with and without displacement. Taking into account the displacement factor, primary and secondary displacement are distinguished. The primary displacement occurs under the influence of a traumatic force at the moment of injury, the secondary one is formed due to the traction of muscles attached to bone fragments. There may be a displacement in width, length, angular or rotational (rotation of one fragment relative to another). All broken are divided into stable and unstable. With stable fractures (usually transverse), the fragments are well held in the correct position. With unstable (oblique, helical), there is a pronounced tendency to secondary displacement due to increasing muscle contraction.
In addition to the usual broken arm, there are fractures of dislocation – injuries in which a combination of fracture and dislocation of the bone is simultaneously observed. Usually fractures occur with intra-articular injuries, but there are other combinations, for example, a fracture of the diaphysis of one of the forearm bones in combination with a dislocation in the elbow or wrist joint (Galeazzi and Monteji injuries). Broken can be complicated by damage to blood vessels and nerves.
Types of arm fracture
Shoulder fractures
Shoulder fractures account for about 7% of the total number of fractures. The most common are injuries to the surgical neck of the shoulder. Elderly patients suffer more often, injury occurs when falling on the arm. The joint is edematous, painful with movements and palpation, movements are sharply limited. To confirm the diagnosis, an X-ray of the shoulder joint is performed. Treatment is usually conservative – a closed reposition followed by the application of a Dezo bandage, a diverting splint or a tourniquet. In case of unrepaired and unstable fractures in patients of working age, surgical treatment is indicated – osteosynthesis of the surgical neck of the shoulder neck with a plate or spokes.
Fractures of the shoulder diaphysis are usually detected in middle-aged and young people. The cause is a direct blow, twisting of the arm (“police fracture”) or falling on the arm. Concomitant damage to the radial nerve is possible. The injury is manifested by pain, swelling, deformation, pathological mobility, crepitation and sharp restriction of movements. If the nerve is damaged, there are violations of sensitivity and movement in the zone of innervation of the radial nerve. The diagnosis is clarified with the help of shoulder x-ray, if nerve damage is suspected, a neurologist or neurosurgeon is prescribed.
Treatment can be conservative or operative. When choosing a conservative tactic, an extension is applied, which, after the formation of the primary corn, is replaced with a plaster bandage. The absolute indication for surgery is an unsuccessful attempt to compare fragments using skeletal traction, interposition of soft tissues, old trauma and the threat of nerve damage. In some cases, surgical intervention is performed according to relative indications for early activation of the patient and prevention of the development of post-traumatic contractures. Osteosynthesis of the humerus with a plate or an intraosseous nail is possible.
In case of nerve damage and a good comparison of bone fragments, conservative treatment is possible: immobilization, exercise therapy, physiotherapy, taking medications that promote nerve regeneration. In the absence of signs of nerve regeneration for several months, surgical intervention is indicated – neurolysis and plasty of the nerve trunk using an autograft from the superficial nerve.
Injuries to the lower end of the shoulder can be extra-articular (supracondylar) intra-articular (condylar). Supramondylar fractures include extensional and flexion injuries, peremondylar fractures of the head, as well as V- and T-shaped fractures of the block. Usually the damage is the result of an indirect injury – a fall on the elbow or on the withdrawn and outstretched arm. They are manifested by swelling, pain, joint deformation and sharp restriction of movements.
The diagnosis is confirmed by radiography of the elbow joint. In case of broken arm, immobilization is carried out without displacement. In the presence of displacement, an operation is performed to restore the congruence of the articular surfaces – osteosynthesis of the condyles or condyles with a plate, screws, spokes and bolts-ties. In the recovery period, physiotherapy and physical therapy are prescribed for fractures of the upper and middle third of the shoulder. In case of intra-articular injuries, physiotherapy is contraindicated.
Forearm fractures
Forearm fractures account for 11-30% of the total number of fractures. More often they occur with a direct mechanism of injury, the direct cause of a broken arm is usually a blow to the forearm, a fall from a height or an accident. As a rule, both bones break, less often – one (radial or ulnar). It is characterized by sharp pain, swelling, restriction of movement and deformation at the site of injury. With diaphyseal broken arm, crepitation and pathological mobility are often detected. To clarify the diagnosis, radiography of the affected segment is performed.
In case of isolated fractures of one of the forearm bones, damage to Galeazzi and Monteggi should be excluded. Galeazzi injury is a fracture of the shaft of the beam in combination with a displacement of the head of the ulna in the area of the wrist joint. In such cases, X-ray of the forearm and radiography of the wrist joint are performed. Damage to the Monteggi includes a fracture of the diaphysis of the ulna and dislocation or subluxation of the beam head in the elbow joint. With such injuries, an X-ray of the forearm and an X-ray of the elbow joint are necessary.
In case of broken arm without displacement, a blockade is performed, a plaster (ordinary or plastic) is applied, after the immobilization is stopped, physiotherapy, massage and physical therapy are prescribed. With diaphyseal fractures with displacement, surgical operation is indicated – osteosynthesis with a pin, plate or Ilizarov apparatus. In case of Galeazzi and Monteggi injuries, closed reposition and immobilization with a plaster cast are performed, if it is impossible to correct and unstable fractures, surgical interventions are performed.
Fractures of the hand
They account for more than 30% of the total number of skeletal injuries. Occur as a result of a fall or a blow to the brush. Injuries to the wrist bones are rare. A complicating factor in injuries to the navicular bone is a high number of ungrown fractures, resorption of fragments, the formation of cysts and false joints. Treatment is conservative, in the absence of fusion and the development of complications, operations are performed – open osteosynthesis, removal of a fragment deprived of nutrition or arthrodesis of the wrist joint. Fractures of other wrist bones, as a rule, heal without complications.
Fractures of the metacarpal bones are often observed, can be open or closed, multiple or single. They are manifested by swelling, cyanosis, pain and difficulty in movement. Sometimes pathological mobility and visible deformity are detected. To confirm the diagnosis, a radiography of the hand is prescribed. Conservative treatment – closed reposition, plaster. In case of unstable broken arm and an unsatisfactory result of the reposition, open osteosynthesis, skeletal traction or closed fixation with spokes are performed.
Finger fractures are also widespread. They can be closed or open, out- and intra-articular, comminuted, helical, transverse or oblique. The diagnosis is clarified using radiography of the fingers of the hand. Treatment is more often conservative. If it is impossible to match or hold the fragments, closed or open fixation with a spoke is used, sometimes skeletal traction is applied.
