Forearm fracture

introduction

The bony structure of the forearm is made up of two elongated bones - of the Cubit (Ulna) and the spoke (Radius). If the palm of the hand is turned upwards, the radius is on the thumb and the ulna on the little finger. A forearm fracture can proximal (near the elbow), medial (midway between elbow and wrist) and distal occur (on the wrist).

The distal radius fracture, i.e. the fracture of the spoke near the wrist, represents the most common fracture of humans in general: About 25% of all bone fractures are due to the so-called Colles fracture on the distal radius. Since there are over 20 different muscles in the forearm, a fracture often leaves one after it has healed Restriction of movement hand in hand. In the case of a forearm fracture, this can also be triggered in particular by injury to one of the many nerves.

Depending on localization there are differences in complications, healing time and primary care of the fracture.

causes

Particularly common causes of a forearm fracture are Falls and injuries during sports and work. At the complete break of Radius and ulna it is a so-called "Complete forearm shaft fracture". Usually only one of the two forearm bones is affected.

Typical for the distal forearm fracture According to Colles, the fall forward is on the outstretched hand. One speaks here of one Extension fracture. This fracture is often considered to be relatively complicated, as the bone structure in the wrist and at the transition between the radius, ulna and wrist bone is complex.

A medial forearm fracture usually arises after Dream, e.g. in a car accident or as a result of a sports accident. While the longitudinal load on the ulna and the radius can be relatively high, transverse loads quickly lead to a fracture. But also here are Falls - a common cause, especially in old age. Patients usually fall to the side due to unsuitable footwear, "tripping hazards", taking medication or age-related frailty, and catch the fall with an arm bent or outstretched.

If the fracture takes place further proximally, i.e. close to the elbow, one speaks of one proximal forearm fracture. The causes of this relatively rare fracture are also Dream after traffic accidents or sports injuries. This can lead to a Blast of the olecranon come, the bony end of the ulna. It corresponds to what is colloquially referred to as "elbow".

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Special fracture shapes

A Galeazzi fracture is the combination of a fracture of the radial shaft, dislocation of the ulna, and rupture of the interosseous membrane - the membrane between the radius and ulna. It is usually preceded by a fall on the outstretched arm. Since there are several affected bone compartments, a plaster cast alone is not sufficient. Osteosynthesis is usually aimed at using plates or screws, so that the separated bones are artificially fixed to one another.
Read more about this type of fracture at: Galeazzi fracture

A Monteggia fracture is a fracture of the proximal ulna with dislocation of the radial head out of its socket. Here, the head of the radius must first be repositioned before supplying the bone can be initiated.
Read more about this type of fracture at: Monteggia fracture

The so-called greenwood fracture is also typical of a forearm fracture. It is a bending fracture of the bone, in which, similar to when you bend a damp or green branch, the bone core is broken, the bark (or in humans: the Periosteum), however, remains. If the degree of bending is low, the restoration is conservative with plaster of paris; if the axis deviation angle is greater, the upset side is also initially broken before the restoration can take place.
Read more about this type of fracture at: Greenwood fracture

Symptoms

At a Broken bone a distinction is made safe and unsafe fracture signs.

Unsafe fracture signs are:

  • pain
  • swelling
  • bruise
  • Restriction of movement
  • overheat

Safe fracture signs are:

  • Visible axis misalignment of the bone
  • "Crepitation noises" (crunching noises when moving the bone)
  • visible bone fragments
  • abnormal mobility

Patients also often hear the bone breaking, at the moment of breaking a cracking sound can be heard, like breaking a piece of wood. Since the Periosteum with many nerve fibers is streaked, it always comes at first severe pain. These can subside when the arm is no longer moved. Pain generally only occurs when the periosteum is touched and stretched. A broken arm that doesn't move doesn't have to be painful.

It should also be borne in mind that immediately after the trauma occurs Pouring adrenaline which is the Modulates and diminishes pain. You are literally “in shock”. A good example of how strong this "suppression reaction" can be is provided by an incident from the army: Since the adrenaline level is too high in combat, soldiers examine each other in suspected cases and not themselves for wounds. One tries to rule out that any injuries to one's own body are simply overlooked. The Shock reactionwith relative painlessness up to an hour last for. Appropriate pain medication should already have been initiated by a doctor during this time.

diagnosis

The Means of choice to diagnose a forearm fracture is roentgen. For a short time, X-rays are directed at the suspected area, whereby the denser bone is shown brightly in front of the water-containing muscle and fat tissue. Fractures are on x-rays relatively easy to spot, the procedure is cheap and does not take long.
To the Protection of the rest of the body in front of the X-rays is a Lead apron carried. The radiation exposure is in the range of 0.5 millisievert. For comparison: the total radiation exposure per person in Germany in 2005 was around 2.5 millisievert.

However, an X-ray does not necessarily have to be made: even that clinical examination taking into account the fracture signs mentioned above can give an indication of a break.

therapy

Acute care

At this point a few more notes on acute care of a broken bone: It is primarily important stop any bleeding, as up to half a liter of blood can be lost through the forearm. In an emergency, this is usually done via a firm setting of the upper arm. It is essential to ensure that the blood supply is not cut off to such an extent that tissue dies.

It is also best to stick to the easily memorable PECH scheme:

1. Break (Immobilization)

2. ice (Cooling the arm to prevent swelling)

3. Compression (Applying a pressure bandage)

4. Elevate (To decrease the blood flow from the wound)

Furthermore, a Repositioning must be done by a doctoras blood vessels and nerves can be pinched in the event of improper care. In extreme cases, this leads to the death of the arm. The first point of contact after emergency care is the hospital outpatient department or the doctor you trust!

Operation and conservative therapy

Therapy can conservative or operative respectively. There are certain guidelines, but the ultimate treatment method is mainly at the discretion of the attending physician - and of course the patient being treated. The rule of thumb is that simple and straightforward fractions just like that conservative, so with plaster of paris, can be supplied while Comminuted fractures and complicated hernias by means of Osetosynthesis process must be surgically supplied.

In the conservative therapy becomes the arm in a so-called "Finger trap" clamped: The fingers are fixed overhead in the finger trap and weights are attached to the angled upper arm. After a good 10 minutes, the tissue is stretched so far that the two broken ends of the bones no longer lie on top of each other. On the other hand, after this time, involuntary counter-tensioning by the patient is no longer to be expected, so that the fracture can be reduced more easily. Once this has happened, the procedure described above takes place Supply with a plaster of paris. Here too the plaster of paris has to be 6 weeks long to be worn.

A surgery is mostly at complex multiple hernias, elderly patients and Polytrauma aimed at. In the Osteosynthesis become Titanium screws or plates used, which are screwed into the bone in such a way that the fragments are put back together and stabilized. The use of the materials depends on the type of break: While the two bones can be "simply" screwed onto one another in the case of a longitudinal fracture, a titanium plate is recommended for a smooth break, which fixes the bone ends together. So-called "Kirschner wires" are also often used for this, with which the two bones are pulled together intramedullary - i.e. lying in the medulla. Kirschner wires are also suitable for fixing smaller, detached pieces of bone to the bone.
An operation can usually be done in local anesthesia be performed. Especially in the case of a forearm fracture, the nerve fibers of the forearm are subjected to local anesthesia, the so-called Brachial plexus anesthesia, stunned. This relatively uncomplicated procedure is also called "axillary blockade" because the brachial plexus supplying the arm is located in the armpit area.
An operation takes at least half an hour, depending on the severity of the fracture. Particular attention is paid to the Blood and nerve supply of the forearm. Trapped arteries or nerves can lead to complications such as loss of sensitivity, restricted mobility or even death of the arm during the healing process. However, various clinical tests and X-ray controls ensure that such complications are rare.

forecast

Forearm fractures usually heal without complications within 6-8 weeks. The arm can then be fully loaded again. It is more critical with patients who are under osteoporosis Suffer. In this disease, which affects bone remodeling, the bone becomes increasingly porous, which encourages renewed breakage or loosening of the screws and plates. Particular caution is required in these patients, as the bone substance is also less resilient from operation to operation.

How long do I have to wear a cast?

A plaster is used for both conservative and surgical treatment. Titanium screws are very tough, but they can tear out of the bone. To Immobilization and immobilization a plaster of paris is therefore applied. It consists of a bandage material that hardens quickly after it comes into contact with water. Within 10 minutes, a solid framework is created around the bone, which can then grow back together in peace.
Osteosynthesis is usually used for forearm fractures completed after 6 weeks. That is how long the plaster of paris should be worn. A Follow-up check of the arm takes place through X-ray control and clinical examination.