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Forearm fracture

Forearm fracture: Isolated fracture of one of the two forearm bones - as Ellen fracture (Ulna fracture) or Broken spoke (Radius fracture) - or both forearm bones at the same time as complete forearm fracture. The radius is most frequently affected, both forearm bones less often, in exceptional cases only the ulna. The cause is usually a fall on the outstretched arm. In adults, fractures in the shaft area of ​​the forearm are almost always operated on, whereas fractures in the wrist are only operated if the fragments are moved more strongly. If no significant misalignment remains, forearm fractures usually heal without lasting discomfort or loss of function.

Leading complaints

  • Severe, movement-dependent pain in the forearm and / or wrist with painful restriction of movement
  • Increasing swelling of the forearm or wrist
  • Often visible misalignment (kinking of the forearm in fork position or bayonet position of the wrist).

When to the doctor

The same day if

  • the symptoms mentioned above occur after a fall.

The illness

The forearm consists of two long bones, the spoke (radius) and the ulna (ulna). In the case of fractures of the forearm, a distinction is not only made between which of the two bones is affected. The height of the break is also decisive.

Most often the spoke breaks close to the wrist, which is often referred to as a "broken wrist". However, this designation is incorrect - it is not the joint that is broken, but the lower end of the spoke. The "distal radius fracture"(as the fracture is called medically correct) is not only the most common forearm fracture, but also the most common bone fracture in humans. The other, rarer forearm fractures are either near the elbow (proximal fractures) or in the middle of the bone (medial).

Further classifications

Breakages in the shaft of the ulna or radius can also be classified according to the type of break. Simple breaks can be oblique, spiral, or transverse. In wedge fractures, the wedge may be intact or broken in on itself. Multi-fragment fractures either have an intact intermediate segment (then the bone is broken into 3 pieces) or a fractured intermediate segment, i. H. several fragments.

causes

Typical causes of forearm fractures are - in addition to falling on the outstretched arm - violent bending, compression or twisting of the forearm in traffic accidents. More rarely, a direct impact leads to the injury, for example when defending against a blow (parrying fracture).

Complications

Nerves and vessels run in a narrow space on the forearm, which can easily be injured in the event of a fracture. A rare but dreaded complication of all forearm and wrist fractures is complex regional pain syndrome (CRPS, formerly known as Sudeck's disease). This is a neurological disorder that occurs following trauma and is associated with pain, muscle weakness, and restricted mobility.

Special forms

Monteggia fracture. Here the ulna near the elbow is broken (proximal ulna fracture), at the same time the head of the spoke has slipped out of its socket and the corresponding ligament connection torn. Before treating the fracture of the elbow, the head of the spoke must be adjusted again.

Galeazzi fracture. This fracture is a combination of a broken spoke, dislocation of the ulna from the joint near the wrist between ulna and radius and the tear in the periosteum between the radius and ulna. Surgical treatment and fixation of the fragments with plates or screws are required to restore the stability of the forearm.

Greenwood quarry. This break is an incomplete break in which the periosteum does not tear or only tears in a very small area. It occurs particularly often on the forearm, more on this under green wood breakage.

Diagnostic assurance

Physical examination. The first indication of a broken forearm is provided by the doctor * in the typical relieving position, in which the healthy hand supports the injured and painful arm. A pressure pain in a typical place on the forearm confirms the suspicion. A visible misalignment of the forearm or wrist, grinding noises when moving the arm and abnormal mobility are considered to be certain signs of broken bones.

Indications of an impending CRPS are the hardened muscles on the forearm and pain when passively stretching the fingers. In order not to overlook an injury to nerves and vessels, the doctor * checks the DMS status, i. H. Blood circulation, motor skills and sensitivity of the affected arm.

  • Damage to the radial nerve is noticeable through the so-called drop hand. The patient cannot stretch his hands and fingers, which is why they hang limply from the raised forearm.
  • If the ulnar nerve (nervus ulnaris) is damaged, this leads to disorders of the inner hand muscles and sensory disorders on the outside of the hand. The result is the clawed hand, in which not the metacarpophalangeal joints of the fingers, but the end joints, can be flexed.
  • If the median nerve is affected, there is a risk of paralysis of the ring finger and little finger. Since these can no longer be stretched out, one speaks of a "hand of oath". In addition, the sensitivity of the thumb and forefinger is disturbed.
  • If the arm artery (arteria brachialis) is affected, the wrist pulse is weakened or absent.

Technical investigations. X-rays confirm the diagnosis and help the doctor with the therapy decision. If Sudeck's disease is suspected, the doctor will arrange for a compartment pressure measurement, and if there is evidence of vascular damage, an angiography, i.e. a radiological examination of the vessels.

Differential diagnoses. Pain and restricted movement of the arm can also be found in other fracture injuries (broken elbow, broken upper arm) as well as in elbow dislocations and Chassaignac's paralysis. Paralysis and sensory disorders in the hand can also be caused by a supinatorial syndrome or an ulnar channel syndrome.

That's what the doctor does

Conservative treatment in adults

In adults, conservative treatment of forearm hernias tends to be the exception. Because of the special anatomy of the forearm, the position of the bones in the correct axis is important. Even small deviations disturb the important turning movements of the forearm. In addition, the forearm would have to be immobilized for a long time to heal. As a result, ligament structures and muscles shrink and mobility is endangered. Conservative treatment is therefore only an option in the following situations:

  • Contraindication to surgical treatment, e.g. B. Patients with a greatly increased risk of surgery
  • Incomplete fractions
  • Simple, unshifted fractures of only one of the two forearm bones.

Breaks in the shaft area. Here the doctor first sets up the fracture and then immobilizes the arm in an upper arm plaster splint, later in a closed upper arm cast for 4 to 10 weeks. She checks the healing process with regular x-rays and adjusts the duration of the immobilization if necessary.

Fractures near the wrist. In the case of fractures that are barely displaced or not at all, the doctor first sets up the fracture under local or brief anesthesia. Then, depending on the location of the fracture, she puts on an arm splint made of plaster of paris. If the soft tissues are swollen after a few days, she replaces the open splint with a completely closed plaster cast that remains for another 4-6 weeks. X-ray controls may help the doctor to monitor the healing progress. If the fragments slip despite the plaster cast immobilization, an operation is necessary.

Surgical treatment in adults

In adults, doctors usually treat open or displaced fractures, complete forearm fractures and fractures with accompanying vascular injuries surgically. The patient is admitted to the hospital for this purpose. If possible, the operation is carried out within 6 to 8 hours after the injury, in the case of open or vascular and nerve injuries also immediately in an emergency.

Fractures in the area of ​​the shaft The surgeons almost always fix it with a plate and screws made of titanium. After the operation, there is no need to immobilize it in a cast. Often, however, the arm is placed in an upper arm splint for a day or two to promote healing and reduce pain. If the inserted metal parts do not cause any discomfort, they stay in the bone. Otherwise, they will be removed 1.5–2 years after the operation.

Fractures near the wrist surgically stabilizes the doctor when the fragments are displaced. This is especially true when the joint surface is also affected. For surgical stabilization, the surgeon uses wires, screws and metal plates, depending on the shape of the fracture, and an external tensioner for soft tissue injuries or pronounced bone fragments. An additional plaster restraint is usually dispensed with. The doctor removes wires and tensioners after 4–6 weeks, screws and plates usually only after 6–12 months.

After the operation

Passive exercise therapy begins in the first few days, followed by active exercises and muscle-building training after about 2 to 3 weeks. 12 weeks after the operation, the doctor checks the healing of the bone using an X-ray. If everything is in order, the patient can carefully put weight on the arm again and begin rehabilitation. After 4 months lifting heavy loads is allowed again, after about 6 months of strenuous exercise.

Treatment in children

In general, broken bones in children a moderate kinking or displacement is more likely to be tolerated than in adults, since a misalignment is usually compensated for by further bone growth. However, there are no standardized recommendations as to which axis deviation is unproblematic - the decision as to whether and how a possible axis error should be corrected is therefore made individually. In the case of axis errors> 15 °, however, movement restrictions in the turning movements of the arm are to be expected.

Conservative treatment. The following forearm fractures are suitable for conservative treatment:

  • Stable, incomplete, unshifted and axially aligned fractions
  • Axially aligned green wood fragments
  • Unstable, but axially aligned, non-displaced isolated spoke or elbow fractures (only under close x-ray control).

The arm is immobilized in a cast for about 3 to 4 weeks. At the beginning, after about 10 days and after the cast has been removed, the doctor * checks the correct position of the bones and the bone healing with the help of x-rays.

After the cast has been removed, the child mobilizes on its own; physiotherapy is not required. If everything is OK at a further clinical check 2 to 4 weeks after the cast has been removed, the child can go back to sports.

Operative treatment. Doctors recommend surgery for the following forearm fractures:

  • Unstable breaks
  • Greenwood fracture of both bones
  • Combination of a complete shaft fracture of one forearm bone and a greenwood fracture of the other
  • Monteggia fracture, Galeazzi fracture.

If possible, the doctors will adjust the fracture under X-ray control. Then they open up the area over the fracture and fix the bone fragments in place. Depending on the type of injury, two techniques are available: The surgeon usually stabilizes fractures in the shaft area with an elastic nail, which she inserts into the medullary cavity. For fractures near the joint, on the other hand, she uses thin wires that cross the bone.

There is no need to immobilize the arm after the operation. However, if the pain is severe, an arm sling or splint is allowed for a few days. Physiotherapy is usually not required. 4 weeks after the operation, the doctor will check the bone healing using x-rays. If everything is okay, sport is allowed again. The metal is removed no earlier than 3 months after the operation. To be on the safe side, the doctor checks beforehand whether the break is completely ossified and the bone is stable again.

forecast

Simple forearm fractures usually heal within 6 to 8 weeks without any consequences. Axis misalignments> 15 ° threaten movement restrictions when turning the forearm.

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What you can do yourself

Immediate cooling with ice packs or cold packs relieves pain and reduces swelling. When being transported to the doctor, the injured arm often hurts less if it is bent and held in front of the chest with a cloth or piece of clothing.

Note: With injuries to the arm or hand there is always a risk of swelling, which is why rings or other jewelry should be removed early.

Complementary medicine

For pain relief and to support the healing process, complementary medical measures include v. a. Magnetotherapy, homeopathy, and acupuncture all into consideration.

Authors

Dr. med. Michael Bedall in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 16:28


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.