Coronoid process of the elbow joint. What is a fracture of the elbow joint and how to treat it correctly The coronoid and olecranon processes are enlarged

Part of the trochlear notch, which connects to it at the humerus. In the second case - the anterior process on the branch of the mandible, the place of attachment of the temporalis muscle.

The structure of the lower jaw

The jaw apparatus is formed by 2 jaws - the upper fixed and the lower movable. The latter is articulated with the skull. The mandible has a horseshoe-shaped body and extends upward under obtuse angle branches that thin out towards the end.

The anterior branch forms the coronoid process. The temporalis muscle is attached to it. The correctness of jaw movements to a large extent depends on this process. If it is broken, the mouth simply will not open. The second process, the posterior one, is condylar, which forms an articulation with the skull - the temporomandibular joint (TMJ). Both processes have 2 surfaces - external and internal, and 2 edges - anterior and posterior.

The anterior edge passes into the coronoid process, and the posterior - into the articular. Between them there is a deep notch. The temporal ridge runs along the middle part of the coronoid process, and the tendon of the temporal muscle is attached to it.

The TMJ is a combined joint, so its movements can occur in 3 planes: the joint can rise and fall (opening and closing the mouth), vertical and horizontal displacements. The joint is supported by ligaments.

Pathologies of the lower jaw

All diseases related to the joints can also be found in the mandibular joint. The most common are arthrosis, arthritis, osteoporosis, congenital anomalies and injuries.

Of course, arthrosis is more often observed, in which degenerative-dystrophic changes in bone tissue occur in the limbs and spine, which receive heavy loads, but the joints of the skull are not immune from them.

Types of arthrosis of the jaw

One of the criteria for systematizing pathology is its etiology. Arthrosis can be primary (occurs after 50 years and is associated with aging of the body) and secondary (occurs against the background of existing diseases), it is more frequent.

Among the provoking factors are:

tooth loss;
broken bite;
maxillofacial injuries;
unsuccessful dental prosthetics;
dental operations;
chronic arthritis of the TMJ;
increased abrasion of teeth;
grinding of teeth (bruxism).

According to the x-ray picture, arthrosis is sclerosing and deforming. Signs of sclerosing:

compaction of bone tissue;
narrowing of the joint space.

Signs of a deforming form:

thickening of the articular surfaces;
osteophytes;
at a late stage - a sharp deformation of the articular head.

The coronoid process is not part of the joint, but osteophytes in arthrosis necessarily cause its damage.

Injuries of the processes of the lower jaw

The most common type of injury is fractures. The lower jaw is a rather fragile structure, so its injuries are not uncommon. A coronoid fracture occurs when there is a strong blow to the chin from top to bottom. The treatment is difficult, the rehabilitation period is long.

If the coronoid process of the jaw is broken, then when you try to open the mouth, the jaw moves towards the injury. This is accompanied by severe pain. An accurate diagnosis will be made with a lateral x-ray at the maximum opening of the patient's mouth.

Prevention of jaw fractures

The most frequent fractures of the jaw (fractures of the coronoid process of the lower jaw, including) were observed in children from 7 to 14 years old, which is associated with their increased physical activity.

So, preventive measures:

To avoid falling from a height, a child must be constantly supervised by adults.
When playing sports, individual protective devices are required - knee pads, elbow pads, helmets, belts.
When driving in a car, children are required to use child seats, and adults must wear seat belts.
Both adults and children should try not to get into situations of fights and brawls with blows to the face or falls.
If we are talking about extreme sports - use protective equipment.
Teeth should not be tested for strength by cracking hard nuts, etc.
The load on the jaw must be adequate. You can't chew gum 24 hours a day.
AT Everyday life don't open your mouth too wide.

Elbow fracture

It is considered a complex injury and is recorded in 20% of cases of fractures. is quite complex, so an elbow fracture is considered dangerous due to many irreversible complications and a very long healing time.

Anatomy of the elbow joint

The elbow joint when viewed from the front consists of 3 bones: the ulna, radius and shoulder.

Behind the joint in sequence:

brachial bone;
olecranon;
radius and ulna;
coronoid process of the ulna.

Any part of the joint can be injured, and treatment and symptoms will vary.

Causes of process fractures

A fracture of the condyle occurs with direct trauma - if, when falling from a height, the falling arm is extended. In this case, the fracture is often displaced.

In case of a fracture of the coronoid process of the ulna, we are always talking about an indirect injury - a fall on back side forearms with maximum flexion.

Shaft fractures of the humerus occur from a direct blow (fracture from a club). It usually happens in car accidents and fights.

In addition to these reasons, fractures of the coronoid process of the ulna can occur even with the most minimal grazing of the bone. This is typical for osteoporosis, arthrosis, osteoarthritis.

Process fracture

Fractures of the coronoid process of the ulna in an isolated form are rare. In case of a bruise or fracture due to a fall from a height, the humerus, as it were, knocks down the process with force and fragments it. In addition, he suffers from the back, but most often his defeat occurs in general, his fracture is rare because it is deeply hidden by a significant layer of soft tissues. The base or the very top breaks. Comminuted fractures of the coronoid (medial) process practically do not occur.

Symptomatic manifestations

When examining the victim, pronounced edema and ulnar hematoma are noted due to damage to soft tissues. The joint itself is deformed, at the site of the protrusion of the condyle, the skin sinks (this is clearly visible in the first minutes of the injury, then the edema spreads and everything disappears).

A fracture of the coronoid process of the ulna may have mild symptoms or manifest itself as follows:

pain with the transition to the fingers;
immobility of the elbow joint - complete or partial;
swelling and hematomas.

They can also be with external damage to the skin, muscles, blood vessels, and nerves.

If a fracture occurs with displacement of fragments, the victim himself cannot straighten his arm at the elbow. Severe pain interferes. You can passively extend your elbow. With a fracture of the coronoid process without displacement, movements in the elbow joint are possible, but severely limited.

Diagnostic measures

Usually, for diagnosis, it is necessary to take an x-ray in two projections: direct and lateral. With the coronoid process, the situation is different: pictures in 2 projections will not give a result.

For diagnosing, it is necessary to position the hand so that the process leaves the zone of superposition of the shadow of the ray head. To do this, the arm is placed in such a way that the process and epicondyle of the shoulder are in contact with the cassette. The forearm should remain in half pronation and in a 160 degree flexion position.

Pronation means turning the arm inward. The direction of the x-ray should be aimed at the coronoid process. Then it becomes visible, emerges from the shadow of the radius, and the diagnosis of the fragment becomes 100% successful.

Treatment

Treatment of the ulna with a fracture of the coronoid process can be of two types: conservative or surgical. With improper therapy or its complete absence, the most common complication is improper fusion, due to which the joint becomes immobile or limitedly mobile.

Conservative treatment

When treating a fracture of the coronoid process, reposition is not required, since there are no pronounced displacements. Treatment of the appendix is carried out on an outpatient basis for 6-8 days, while the arm is fixed with a posterior plaster splint, the forearm is bent at an angle of 60-65 degrees. Then a complex of functional treatment is prescribed. Ability to work is restored already on the 6th day.

Immobilization

Applied for 3-4 weeks. It starts from the fingers, ends with the shoulder. After 3 weeks, the splint is removed, and the joint is to be developed. The entire course of treatment with a rehabilitation period takes from 1.5 to 2 months.

Physiotherapy and exercise therapy

After treatment, the course of restoration of the joint begins. For the coronoid process, this means:

Physiotherapy procedures.

exercise therapy

Exercise therapy is an important part of treatment that helps restore joint mobility. If it is excluded and not carried out, joint contracture may occur when, after the end of treatment, the joint remains motionless. Exercises are performed already on the 2nd day of the cast under the supervision of a rehabilitation doctor.

Exercises are always individual and depend on the age of the patient and the severity of the fracture. The developed movements are intended for plaster-free areas.

The simplest exercise for a fracture of the coronoid process - placing a hand behind the head - helps relieve swelling and normalizes blood flow. On the 10th day after the plaster, the muscles are trained under the bandage. Next come flexion and extension at the elbow.

A set of therapeutic exercises is performed 4 times a day, with 10 approaches.

You can not engage immediately actively, increasing the pace and load is only gradual. The exercise therapy complex is selected individually, taking into account the severity of the fracture.

It is good to combine exercise therapy with physiotherapy: magnetotherapy, electrophoresis, UHF, mud therapy. If exercise therapy and physiotherapy are prescribed at the beginning of recovery, then massage is performed in the middle of rehabilitation and at the end.

With a fracture of the coronoid process, massage is absolutely impossible to do because of the risk of developing ossifying myositis. Even after recovery, it is better not to overload the joint, because in this case the process is very fragile.

First aid

The first thing to do is call an ambulance. Then the victim needs to be given an analgesic. The hand should be immobilized; for this, any improvised means can be used as splints: thick cardboard, plywood, board. A splint is placed on the elbow to immobilize the hand, wrist, and shoulder joints. As a rule, the arm must be flexed for fixation, but if this is painful, the limb is left in its original position and fixed. If left untreated, joint contracture develops.

Arm fixation

To fix a hand with a fracture of the coronoid process in the emergency room, gypsum is not applied, only plaster splints, orthoses, splints, fixators and bandages can be used.

Tissue retainers may well replace plaster casts, while they also provide tissue massage. An elbow brace is an external orthopedic device that protects the joint from injury.

Elbow brace is very popular with athletes, it unloads the joint and relieves pain. It can also be used for prevention, because it unloads the joint during training. A bandage is very valuable for arthrosis in the elderly, it slows down the development of degenerative processes and speeds up recovery.

Prevention

With a broken arm, the whole process of immobilization is important from the very beginning. He does not choose on his own. All prescriptions of the doctor should be strictly followed.

Other pathologies of the elbow joint

These are arthritis, arthrosis and deforming arthrosis, osteoporosis, dysplasia.

Arthrosis develops in the joint, but as the process progresses, bone outgrowths grow, which also cover neighboring bone tissues, for example, the same coronoid process. Osteoarthritis usually occurs after 45 years of age. The risk group includes women during menopause, athletes (tennis players) and people whose profession is associated with heavy loads on the elbow (for example, writers, musicians, professional drivers).

Causes of arthrosis of the elbow joint:

elbow injury that occurred at a young age;
metabolic disease;
rheumatism;
chronic infections of ENT organs;
heredity.

Symptoms of osteoarthritis of the elbow joint

The main symptoms include:

pain during movement and walking;
pain at rest in later stages;
crunching when moving from rubbing the bones against each other, it is accompanied by pain;
stiffness of the joint due to narrowing of the joint space, growth of spikes and muscle spasm.

Often with elbow arthrosis, the so-called Thompson symptom is observed - the patient cannot hold the hand bent into a fist in the back position. He quickly spreads his fingers. The elbow joint is modified - osteophytes grow, the elbow swells.

Deforming arthrosis of the elbow joint accounts for 50% of all elbow arthrosis. Complaints are similar, the pain is constantly growing.

Osteology in dogs

In dogs, 2 coronoid processes are the same as in humans - in the lower jaw and elbow joint.

Elbow dysplasia (ODD) in dogs is an inherited disease in which there is an abnormal joint structure with improper articulation of the elbow. Such an incorrect joint is subject to wear, signs of arthrosis develop faster in it. If left untreated, it progresses rapidly.

There is no diagnosis of dysplasia itself. This is the collective name of all anatomical pathologies formed during the period of embryogenesis and in the first months of life. Dysplasia means the abnormal development of any tissues, organs and bones. With dysplastic processes in the elbow joint, there can be 4 types of disorders:

fragmentation (separation) of the olecranon;
chipping of the coronoid process of the ulna;
osteochondritis of the exfoliating type;
discrepancy between the bones of the joint (discongruence).

Various joint pathologies are similar in symptoms. That is why it is so important to seek professional help. Diagnosis can only be made on the basis of x-ray results.

The elbow joint is formed by the connection of the bones of the forearm and the proximal (lower) part of the shoulder. Fractures in the area of the elbow joint include: a fracture of the olecranon, a fracture of the head and neck of the radius, and a fracture of the coronoid process of the ulna.

Symptoms of an elbow fracture

Fracture of the olecranon is a common hand injury. With a fracture of the olecranon, pain is noted along the back of the elbow joint, pain can radiate to the shoulder and forearm. Swelling and bruising extend to the anterior surface of the elbow joint, which is associated with the outpouring of blood in the area of the elbow joint. Also, with a fracture of the olecranon, active extension in the elbow joint is impaired, because the triceps muscle of the shoulder is attached to the olecranon, which is responsible for extending the forearm. Rotational movements of the forearm (supination and pronation) are less affected. The crunch of fragments and visible deformation are felt in the presence of displacement of fragments.

Fracture of the olecranon: a) without displacement, b) with displacement

With a fracture of the head and neck of the radius pain is felt on the anterior surface of the elbow joint, may radiate to the forearm. Bruising and swelling are mild. The crunch of fragments is rarely heard, and visible deformations are not observed, even with the displacement of fragments. A distinctive feature of this fracture is a sharp restriction of rotational movements of the forearm.

Fracture of the coronoid process of the ulna accompanied by pain on the anterior surface of the elbow joint, the pain increases with probing. Limited flexion and extension at the elbow joint. There is a slight swelling over the elbow joint, no deformities are observed.

First aid for a broken elbow

For fractures in the area of the elbow joint, first aid consists in immobilizing the elbow joint with a splint from improvised means, but it should be remembered that if you can’t put a splint on your own, it’s better not to experiment, but to tie your hand on a scarf. The pain syndrome is eliminated by any available analgesics: ketorol, nimesulide, analgin. Do not move the damaged joint and try to set the fracture yourself.

Diagnostics for a fracture of the elbow joint

For diagnosis, an X-ray examination is performed. In some cases, computed tomography is done to confirm the diagnosis.

Elbow fracture treatment

Fracture of the olecranon without displacement are treated by applying a plaster cast from the upper third of the shoulder, with the capture of the elbow and wrist joints. The plaster must be worn for 6 weeks.

If a displaced fracture, then they perform an operation and fix the fragment with a metal wire and knitting needles. The reduction of a displaced fracture rarely brings a positive result, which is associated with the tension of the fragment by the triceps muscle of the shoulder. Next, a plaster splint is applied for 4-6 weeks. After removing the plaster, they begin rehabilitation, the total duration of treatment is 2-3 months. The pins are removed a few months after the injury.

With a fracture of the neck and head of the radius without displacement plaster immobilization lasts 2-3 weeks. If there is a displacement, then they try to fix it, in case of failure, an operation is performed to remove the broken bone fragment. The total duration of treatment is 1-2 months.

Fracture of the coronoid process requires plaster immobilization for a period of 3 to 4 weeks. The total period of treatment with rehabilitation is 1-2 months.

Rehabilitation for a fracture of the elbow joint

From the first days after the injury, we actively move the fingers of the injured hand and the shoulder joint.
After 7-10 days, we proceed to isotonic muscle contractions (muscle tension without movement) under the cast.

2 weeks after the injury, physiotherapy treatment is prescribed - magnetotherapy. After removing the plaster, the range of procedures expands, ozocerite, UHF, electrophoresis, sea salt baths and mud therapy can be used.

After removing the plaster cast, we begin to develop movements in the elbow joint of the injured arm. All exercises are done together with the elbow joint of the healthy side for 10-15 repetitions, with a gradually increasing load, 3-4 times a day. Part of the exercises is performed in a bath with sea salt, which improves the recovery of function and relieves pain.

An approximate set of exercises for the development of the elbow joint:

We close the brushes with a lock, do exercises like throwing a fishing rod, alternately winding the lock for the left and right ear;
Too, but throwing brushes behind the head;
We try to close our hands on our backs;
We put our hands behind our heads, we close our hands in the lock and stretch, straightening the lock with our palms up;
We take a children's car in the brush and roll it on the table, making movements in the elbow joint;
We play with the ball;
We do various exercises with a gymnastic stick, the main emphasis is on flexion and extension in the elbow joint;
After a sufficient decrease in the pain syndrome, we proceed to exercises with dumbbells (weighing no more than 2 kg);
Development of rotational movements in the forearm (supination and pronation) - we bend the elbow joint to an angle of 90 degrees, then we make movements with the forearm around its axis, it is important to make rotational movements with the forearm, not the shoulder.

It is worth remembering that the elbow joint is the most "capricious" for the development of movements. In some cases, the use of special devices is required to develop a persistent movement disorder in the elbow joint.

At first, you should refrain from massage in the elbow area, and you need to massage the muscles of the forearm and shoulder. Only after the removal of inflammation and pain syndrome, you can proceed to a gentle massage of the elbow joint.

Elbow Fracture Prognosis

Fractures of the elbow joint can result in both a quick recovery and restoration of function, and a long-term development of movements that does not bring significant results. All these fractures are intra-articular injuries and are fraught with the development of contracture (limitation of range of motion) of the elbow joint or arthrosis in the remote, several years later, period after the injury.

Doctor traumatologist Voronovich V.A.

An injury to the ulna is a fairly serious injury that, like other complex fractures, requires a longer period of treatment and rehabilitation. This is due to the complex anatomical structure of the bone, its direct connection with the elbow and wrist joints.

The ulna is a paired tubular bone that articulates with the radius and forms the forearm. From below it is connected to the hand, from above to the humerus. In the process of movement of the elbow joint, three processes of the ulna are involved - at the top of the coronal and ulna, and at the bottom of the styloid.

Violation of the integrity of the tissues of the ulna involved in the formation of the elbow joint leads to immobilization of the injured limb. Due to the presence of the joint, limb mobility is observed, important movements and actions are performed - flexion-extension, rotation inward and outward.

Fracture symptoms

In order to correctly establish the diagnosis in case of damage, it is enough to pay attention to the characteristic symptoms of a broken ulna:

swelling in the elbow;
partial immobilization of the elbow joint;
the appearance of a hematoma at the site of injury;
severe pain in the whole limb.

The cause of the injury is a direct blow to the forearm or a fall on an outstretched arm, as well as an increased load on bone tissues affected by a disease that disrupts the structure and reduces bone strength.

Types of injury

The fracture may be open or closed type. Regardless of the complexity of the structure of the elbow joint, their signs do not differ from the symptoms of other fractures:

a common type of injury is a closed fracture, in which the structure of soft tissues is not disturbed and wounds do not form;
fracture open type, on the contrary, is characterized by wounds and damage to the skin by bone fragments. The size of the affected surface depends on the severity of the injury;
comminuted, in terms of symptoms, it is very similar to a closed fracture, but differs in the presence of fragments inside, which are well palpable on palpation;
a displaced fracture of the ulna (Fig. b below) is characterized by a violation of the usual contours of the limb or an unnatural position and outwardly observable appearance of the elbow joint;
a crack is a violation of the structure of the bone surface, does not require long-term rehabilitation and treatment.

The easiest and safest injury is considered to be a crack or closed fractures of the ulna without displacement (Fig. a).

In the direction of the contour of the damage, fractures are classified into:

transverse;
longitudinal;
helical;
oblique;
compression.

The most rare in medical practice is an isolated fracture, similar in symptoms to a transverse fracture without displacement. This is due to the close proximity to the radius, which delays and maintains the position of the resulting fragments. With this fracture, conservative treatment is used with the obligatory use of a plaster cast, which securely fixes the injured area.

An elbow injury is classified as a compound fracture. In case of a fracture of the ulnar and coronoid processes of the bone, surgical intervention is necessary, which is necessary and contributes to the restoration of the motor functions of the limb.

A fracture in the upper part of the ulna complicated by dislocation is called a Montage fracture or parry fracture. It most often occurs due to direct impact or impact to the ulna.

According to the location of the focus of injury, there are:

periarticular (metaphyseal) fractures;
fractures of the ulna inside the joint (epiphyseal), which lead to the destruction of the ligaments, joint, capsule;
fractures in the middle section of the bone (diaphyseal);
elbow injury;
fractures of the coronary processes of the ulna;
damage to the styloid process, located in the vicinity of the hand.

First aid

First aid methods and mechanisms depend on the type of fracture that has occurred. When open, it is necessary to protect the resulting wound from infection, to stop blood loss. It is necessary to apply a sterile napkin and use a tourniquet or belt to stop the bleeding.

Moreover, you need to put a note under the tourniquet (or write it down for yourself) with the exact time of its application, so that in right time loosen it for a couple of minutes. If this is not done, then due to the lack of circulation to the damaged limb, it will begin to die and it will be impossible to return its function. It is necessary to loosen one and a half hours after application, and after a few minutes re-tighten.

It is important to immobilize the injured limb. To do this, use medical splints or improvised means, in the form of flat boards, to which the injured hand is fixed with a rope, bandage or scarf, scarf. Any available pain medications will help the patient get rid of acute pain. Having provided emergency care, it is imperative to refer the patient to a medical institution for subsequent diagnosis and treatment.

Treatment

Often, elbow fractures are combined with dislocation or displacement. This requires the timely assistance of a specialist in order to increase the chance of resuming the normal functioning of the injured limb.

When the integrity of bone tissue is restored, new cells are formed, which subsequently form a callus. The timing of fusion (regeneration of bone tissue) for each patient is individual and depends on the age of the patient, the type of fracture. In the normal course of the treatment process without the occurrence of complications, the period of fusion of the ulna after its fracture lasts about 10 weeks.

In some cases, the fracture is accompanied by damage to the styloid process, located in the lower part of the ulna. Then there is a closed comparison of fragments and plaster is applied for tight fixation. The procedure takes place under local anesthesia.

With an isolated fracture with or without displacement, a plaster splint is applied from behind. In this case, a third of the shoulder should be covered, and the plaster bandage descends to the wrist joint. The duration of immobilization is about 1 month. For rehabilitation measures, the splint is removed from the second week. Therapeutic exercises and hand movement are carried out with extreme care. After that, the bandage is again put on the arm.

In fractures with complications, the patient requires surgery. Its necessity is determined by the doctor on the basis of an X-ray examination, which accurately determines the location of the injury, the number of fragments, and the soft tissues are cleaned from stuck small fragments of the damaged bone. The operation takes place under local or general anesthesia. The method of anesthesia is selected individually and depends on general condition patient's health.

A Monteggia fracture is difficult to treat and in some cases is fraught with complications. It is characterized by:

slow fusion or complete non-union of the ulna,
connection of the ulna and radius;
curvature of the ulna due to improper union;
displacement of the head of the radius.

To avoid complications and increase the possibility of a successful recovery and restoration of hand function, you need to start treatment immediately.

Rehabilitation

During the recovery period after an injury, a number of measures are taken to restore the functioning of the injured limb and normalize blood circulation. There are a number of methods that are carried out under the supervision of a rehabilitation physician.

To reduce pain in a patient, physiotherapeutic procedures are performed using high-frequency electromagnetic fields and modeling currents. Later, electrophoresis is applied.
Massage will improve blood circulation. Therapeutic and physical training complex, selected individually, will soon restore the sensitivity and function of the limb, disturbed by injury.
Such medical procedures as ozocerite, paraffin therapy, thermal baths are also shown. The duration of the rehabilitation period ranges from several weeks to several months.
During the rehabilitation period, an important factor is a balanced diet enriched with calcium-containing products - milk, cottage cheese, cheese, etc.

Effects

The recovery of the patient, the fusion of the damaged bone tissue, and subsequently the quality of his life, largely depend on the qualifications and experience of the doctor involved in the treatment of the injury. The upper limb is an important component of the human skeleton. Its functioning, which does not bring discomfort and inconvenience to the patient, is important.

Ignoring the doctor's prescriptions in the course of treatment or refusal of rehabilitation measures can adversely affect the natural functions, lead to the patient's disability or partial loss, limitation in fulfilling the role assigned to her.

Prevention of fractures

To avoid serious fractures, you need to constantly train the ligaments and joints of the hands. To do this, you need to perform physical exercises with loads. Several times a year, preferably in spring and autumn, you need to use vitamin complexes that will make up for the lack of useful elements in the body.

Violation of the integrity of the coronoid process of the ulna as a result of trauma.

What provokes Fractures of the coronoid process of the ulna:

Fractures of the coronoid process of the ulna more often combined with posterior dislocations of the forearm. Isolated fractures of the coronoid process occur with indirect trauma - a fall on an outstretched arm, as well as with a sharp contraction of the brachial muscle, which tears off the process.

Symptoms of Fractures of the coronoid process of the ulna:

Clinical picture allows suspecting intra-articular damage. The patient complains of pain in the cubital fossa. Swelling is determined in the anterior part of the elbow joint, moderate pain with deep palpation of this area. Painful and limited movement in the elbow joint. X-ray examination is especially informative in such cases. For the coronoid process to be visible on the radiograph, the forearm must be flexed 160° midway between pronation and supination so that the cassettes touch the olecranon and medial epicondyle of the humerus.

Treatment of Fractures of the coronoid process of the ulna:

Attempts at closed reduction in such fractures have been unsuccessful. In cases where the displacement of the broken fragment is small, a posterior plaster splint is applied from the upper third of the shoulder to the wrist joint at an angle of 80-90 ° for 2 weeks, after which a complex of functional therapy is prescribed. If the fragment has shifted into the joint, which is manifested by the blockade of the joint, surgical intervention is necessary: a broken fragment is removed from the anterior approach.

Fracture of the coronoid process of the ulna occurs more often in combination with posterior dislocation of the forearm. Isolated separations of it are rare with a sharp contraction of the shoulder muscle.

Signs: slight swelling in the elbow, hemarthrosis, pain on palpation and movement in the joint. The diagnosis is clarified by radiograph in the lateral projection.

Treatment. First aid - immobilization of the joint with a transport splint in the flexion position. In case of a fracture of the coronoid process with a slight displacement for 2 weeks, a plaster splint is applied (from the metacarpophalangeal joints to the upper third of the shoulder). The forearm is flexed to 90°. Rehabilitation - 3*/2 weeks Ability to work is restored after 1-11/2 months.

With a large displacement of the coronoid process and a multi-comminuted fracture, surgical treatment is indicated: suturing the process, removing small fragments. Immobilization of the joint with a splint - up to 4-6 weeks (in the flexion position up to 80-90°). Rehabilitation - 4-6 weeks. Ability to work is restored after l 1 /2-2 months.

55. Fractures of the olecranon.

56. Internal osteosynthesis in fractures of the olecranon,

57. External osteosynthesis in fractures of the olecranon.

FRACTURES OF THE HEAD AND NECK OF THE RADIUM BONE

Fractures of the head and neck of the radius occur when falling on a straightened arm. Signs: painful palpation of the lateral edge of the elbow, violation

rotational movements of the forearm, crepitation of fragments. The diagnosis is confirmed radiographically.

Treatment . Immobilization of the limb with a transport tire or scarf. In case of fractures without displacement after anesthesia, a plaster splint is applied from the metacarpophalangeal joints to the upper third of the shoulder in the position of flexion of the forearm to 90-100 °. The term of immobilization is 2-3 weeks. Ability to work is restored after 1-1/2 months.

In case of fractures with displacement of fragments, reposition is performed (under anesthesia) by pressure on the head in the direction opposite to the displacement. In this case, the forearm is flexed to 90° and supinated. Immobilization with a plaster splint - 4-5 weeks. Rehabilitation - 2-4 weeks. Ability to work is restored after 11/2 -2 months. Be sure to repeat the control radiograph a week after the reposition. Surgical treatment indicated for failed reposition, with comminuted and marginal fractures of the radial head. Fragments are fixed with 1-2 knitting needles. With marginal and comminuted fractures, resection of the head is indicated. The terms of rehabilitation and restoration of working capacity are the same.

FRACTURES OF THE DIAPHYSIS OF THE BONES OF THE FOREARM

Causes: direct impact, sharp angular deformation.

Signs: deformity, swelling, impaired movement, pain on palpation of the fracture area, pain on load along the axis of the forearm, pathological mobility and crepitus at the level of the fracture. Be sure to check the mobility and sensitivity of the fingers!

With a fracture of one of the bones of the forearm, the deformity and swelling are not so pronounced, and local pain is determined only in the area of the damaged bone. The presence of a dislocation of the head of the radius with a fracture of the ulna prevents flexion of the forearm. To clarify the diagnosis, it is very important to perform radiography of the bones of the forearm throughout (after anesthesia).

Treatment . First aid - immobilization with a transport tire rear surface from the head of the metacarpal bones to the upper third of the shoulder, the forearm is in the position of flexion up to 90 ° (Fig. 58).

In case of fractures without displacement of fragments, a two-long plaster bandage is applied from the metacarpophalangeal joints to the upper third of the shoulder (Fig. 5-9) for 8-10 weeks. Rehabilitation - 2-4 weeks. Ability to work is restored after 21/g - 3 months.

In case of fractures with displacement of fragments, reposition is performed in the position of the patient lying down. After anesthetizing the fracture sites, the arm is placed on a side table, the shoulder is abducted, and the forearm is bent to an angle of 90°. Two assistants gradually (!) carry out traction along the axis of the forearm (traction for the fingers and hand, counter-traction - for a towel thrown over the distal * shoulder section or a wide gauze tape. The traumatologist eliminates the lateral displacement of fragments by squeezing the interosseous gap from the front and back surfaces forearms. After reposition, a posterior plaster splint is applied from the metacarpophalangeal joints to the upper third of the shoulder "and an additional plaster splint on the palmar surface of the forearm and shoulder. The interosseous gap is carefully modeled (it is permissible to insert longitudinal rollers). The splints are fixed with a bandage and a control radiograph is taken ( after 2 weeks, repeat control radiographs!) (Fig. 60).

If the fracture is localized in the upper third of the forearm, then reposition and immobilization is performed in the position of supination of the forearm. For fractures in the middle and lower thirds, the forearm is held in the middle position between pronation and supination (Fig. 61). For the reposition of bone fractures, the forearm is successfully used by the devices of Sokolovsky, Demyanov and others (Fig. 62) with the imposition of plaster casts (Fig. 63).

The term of immobilization is 10-12 weeks. It is important to check their position radiographically 7-10 days after the reposition of fragments and exclude secondary displacement. Rehabilitation - 4-6 weeks. Ability to work is restored after 3-4 months.

Surgical treatment is indicated for unsuccessful reposition, secondary displacement of fragments. For osteosynthesis, flexible metal rods, beams and rod-screws are used, which provide internal compression (Fig. 64). Immobilization with a plaster circular bandage - 10-12 weeks. Rehabilitation - 4-6 weeks. Ability to work is restored after 3-4 months. The use of external fixation devices reduces the period of rehabilitation and disability by 1-1*/2 months (Fig. 65).

In case of damage, Montegi produce osteosynthesis of fragments of the ulna and reduction of the dislocation of the head of the radius (Fig. 66).

Immobilization (10-12 weeks) is performed in the position of flexion and supination of the forearm.

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