Forearm/Elbow Fractures
Forearm Fractures
The forearm consists of two bones, the radius and the ulna, with the ulna is located on the pinky side and the radius on your thumb side.
Fractures of the forearm can occur at different levels: near the wrist at the farthest (distal) end of the bone, in the middle of the forearm or near the elbow at the top (proximal) end of the bone. They can occur through a direct blow (a fall on the forearm or direct impact from an o bject) or indirect injury. The latter is usually secondary to landing on an outstretched arm.
What are the different types of forearm fractures?
Forearm fractures can occur as a single (radius or ulna only) or combined (both bones) fracture.
When both bones are fractured at different levels and there is a joint injury at the wrist or elbow, these are described as Galeazzi or Monteggia fractures:
Galeazzi facture: Most often a displaced fracture in the radius and a dislocation of the ulna at the wrist, where the radius and ulna come together.
Monteggia fracture: Most often a fracture in the ulna and the top (head) of the radius is dislocated at the elbow joint.
What is the treatment for a forearm fracture?
Nonoperative Treatments
A stable, simple and isolated fracture of the ulna (secondary to a direct blow) can be treated with a cast for about four to six weeks. Your doctor will closely follow your progress with X-rays to assure nondisplacement of the fracture and proper bone healing. During this time, weight lifting and bearing is not permitted.
After removal of the cast, you will start physical therapy with specific exercises to regain full range of motion of your elbow and wrist and rotation of the forearm. Your doctor will increasingly allow you to lift weights according to how your fracture is healing.
Surgical Treatments
Surgery is performed in most of the forearm cases and usually performed through one or two incisions at different levels and sides of the forearm. The fractures are reduced and held together with plates and screws. After surgery your forearm will be put in a short splint for comfort and protection. You will not be allowed to lift weight for six weeks after surgery.
Elbow (Olecranon) Fractures
An olecranon (oh-LEK-rah-nun) fracture is a break in the bony "tip" of the elbow. This pointy segment of bone is part of the ulna, one of the three bones that come together to form the elbow joint.
The olecranon is positioned directly under the skin of the elbow, without much protection from muscles or other soft tissues. It can break easily if you experience a direct blow to the elbow or fall on an outstretched arm. A fracture can be very painful and make elbow motion difficult or impossible.
Treatment for an olecranon fracture depends upon the severity of the injury. Some simple fractures can be treated by wearing a splint until the bone heals. In most olecranon fractures, however, the pieces of bone move out of place when the injury occurs. For these fractures, surgery is required to restore both the normal anatomy of the elbow and motion in the joint.
The olecranon (arrow) is the bony point of the elbow.
Anatomy
Your elbow is a joint made up of three bones:
The humerus (upper arm bone)
The radius (forearm bone on the thumb side)
The ulna (forearm bone on the pinky side)
The elbow joint bends and straightens like a hinge. It is also important for rotation of the forearm; that is, the ability to turn your hand palm up (like accepting change from a cashier) or palm down (like typing or playing the piano).
The elbow consists of portions of all three bones:
The distal humerus is the lower end of humerus. It forms the upper part of the elbow and is the spool around which the forearm bends and straightens.
The radial head is the knobby end of the radius where it meets the elbow. It glides up and down the front of the distal humerus when you bend your arm and rotates around the ulna when you turn your wrist up or down.
The olecranon is the part of the ulna that "cups" the lower end of the humerus, creating a hinge for elbow movement. The bony "point" of the olecranon can be easily felt beneath the skin because it is covered by just a thin layer of tissue.
The elbow is held together by its bony architecture, as well as ligaments, tendons, and muscles. Three major nerves cross the elbow joint.
(Left) The bones of the elbow. The olecranon is the "tip" of the elbow and is part of the ulna.
(Right) The major nerves and ligaments are highlighted.
Description
Olecranon fractures are fairly common. Although they usually occur on their own, with no other injuries, they can also be part of a more complex elbow injury.
In an olecranon fracture, the bone can crack just slightly or break into many pieces. The broken pieces of bone may line up straight or may be far out of place (displaced fracture).
In some cases, the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the bone. This is called an open fracture. Open fractures are particularly serious because, once the skin is broken, infection in both the wound and the bone are more likely to occur. Immediate treatment is required to prevent infection.
Cause
Olecranon fractures are most often caused by:
Falling directly on the elbow
Receiving a direct blow to the elbow from something hard, like a baseball bat or a dashboard or car door during a vehicle collision.
Falling on an outstretched arm with the elbow held tightly to brace against the fall. In this situation, the triceps muscle, which attaches to the olecranon, can pull a piece of the bone off of the ulna. Injuries to the ligaments around the elbow may occur with this type of injury, as well.
Symptoms
An olecranon fracture usually causes sudden, intense pain and can prevent you from moving your elbow. Other signs and symptoms of a fracture may include:
Swelling over the "tip" or back of the elbow
Bruising around the elbow. Sometimes, this bruising travels up the arm towards the shoulder or down the forearm towards the wrist.
Tenderness to the touch
Numbness in one or more fingers
Pain with movement of the elbow or with rotation of the forearm
A feeling of instability in the joint, as if your elbow is going to "pop out."
Doctor Examination
Physical Examination
Your doctor will talk with you about your medical history and general health and ask about your symptoms. He or she will then examine your elbow to determine the extent of the injury. During the exam, your doctor will:
Check your skin for cuts and lacerations. In severe fractures, bone fragments can break through the skin, increasing the risk of infection.
Palpate (feel) all around your elbow to determine if there are any other areas of tenderness. This could indicate other broken bones or injuries, such as a dislocated elbow.
Check your pulse at the wrist to ensure that there is good blood flow to your hand and fingers.
Check to see that you can move your fingers and wrist, and can feel things with your fingers.
Although you may have pain only at the elbow, your doctor may also examine your shoulder, upper arm, forearm, wrist, and hand to ensure that you do not have any other injuries.
X-rays
X-rays provide images of dense structures, such as bones. Your doctor will order x-rays of your elbow to help diagnosis your fracture. Depending on your symptoms, he or she may also order x-rays of your upper arm, forearm, shoulder, wrist, and/or hand to determine if you have other injuries.