Broken elbow

definition

The elbow is the colloquial term for the region between the upper arm and forearm, in which, in addition to important nerve tracts and vessels, mainly the elbow joint is located.

An elbow fracture is a fracture of the elbow joint, or the adjacent structures. The term is not clearly defined medically. In practice, however, in most cases it is a fracture of the olecranon, the hard, bony process of the ulna.
The olecranon describes the end section of the ulna (or ulna) and is considered to be the hardest and most stable bone in the body.

Nevertheless, after traffic or sports accidents, for example, the olecranon can fracture, which is partly due to its exposed location. The olecranon is of particular importance because the tendon of the tricpes muscle attaches here. We need the triceps, among other things, to stretch the arm in the elbow joint. If you sit up in an armchair, you need the triceps on both sides and you have to rely on an intact olecranon.

causes

The causes for one Broken elbow can be diverse and are dated Age dependent on the patient.

At younger Patients open the fractures in almost all cases traffic accidents, or Sports accidents back. It is true that Elbow next to the knee as one of the toughest bone on the body, which many martial arts make use of.

However, ours are bone not made of reinforced concrete, and an unfavorable load, such as a fall on the outstretched poor, can cause the Olecranons to lead. While the break in this case extends over the entire width of the Cubit pulls through, it comes to the angled when falling Elbow rather to an invoicing, or "smashing" the Olecranons. In all cases this can also be Elbow joint be affected yourself and result in restricted mobility.

As with young patients Sports and traffic accidents are typical, are simple falls on the elderly Elbow the rule. The causes are then mostly multifactorial: A diminished one Eyesight, Taking medication, and general Circulatory weakness leads to more falls in old age. Because the bone structure is rebuilt with age, and osteoporosis break is not uncommon bone much easier than it was at a young age. The statistics are from the classic Femoral neck fracture listed, but is also the Broken elbow not uncommon after falling in old age. Therefore, in old age it is particularly important to eliminate any tripping hazards in the home and to adjust the settings correctly Medication to pay attention.

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As a former performance-oriented tennis player, I specialized early on in the conservative treatment of the elbow.

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Symptoms

A broken elbow is at first - like any other break - relatively painful.

This is because the fine periosteum that surrounds our bones is stretched and speared. The periosteum is criss-crossed by many small, fine nerve fibers and is extremely sensitive to pain.

Fortunately, the pain subsides as soon as the break point is no longer stressed. This is more difficult with some fractures than with others, the olecranon is mainly stressed by stretching the elbow. This is because a very strong muscle, the triceps brachii muscle, has its attachment to the olecranon and pulls on it with every stretching movement. As long as the arm is not stretched out or the elbow is bumped, the pain is usually bearable.

An important distinction between a broken elbow and a broken elbow is passive mobility.
With passive movement of the forearm by the examiner, the pain in an elbow fracture should be less severe than with forced, active movement.
Severe pain during passive movement suggested involvement of the articular surfaces of the elbow joint.

In addition to pain and reduced mobility, swelling and redness are typical. Since fine blood vessels run under the skin, blood escapes from the ruptured vessels into the subcutaneous tissue in the event of a fracture. The result are the typical "bruises" that each of us has had. If a larger vessel has been injured, it can lead to real bruises. These aren't too bad as long as you don't lose too much blood in your arm.
From a certain amount of blood loss (approx. Over 0.5 liters), depending on your constitution and age, circulatory problems and shock symptoms can occur. Since up to a liter of blood can be lost in the arm, an emergency injury to large vessels must be ruled out.

therapy

The therapy depends on the injury pattern and is usually performed surgically.

The operation again depends on the type of broken elbow.

If the olecranon is fractured into many different parts, plate osteosynthesis is usually used. A plate is implanted under the skin on the bone, and the individual bone fragments are screwed onto the plate like a puzzle. It is of course important - just like with a puzzle - to put the bone fragments in their original position, as otherwise misalignments and crooked growth can occur.

The plate and the screws are mostly made of titanium. They are usually removed from the body within 12 months of the fracture. Significantly longer waiting times are not recommended, as the bone grows into the plate over time and the screws can break off when unscrewing them. In certain cases, however, the plating can also be left in the body.

A stable supply of the elbow fracture is absolutely necessary, since the tendon of the triceps muscle attaches to its back. This strong muscle is responsible for stretching the arm and exerting great force on the bone. Therefore, the healing time for an elbow fracture is given as up to two months, i.e. two weeks more than is normally the case with broken bones.

In the event that the olecranon has not fractured, but has split off from the rest of the ulna, the surgeon uses what is known as a screw osteosynthesis. From the name of the procedure it can already be deduced that a bone (Latin "os") should be synthesized, i.e. connected, by means of a screw. The broken piece of bone is screwed onto the remaining, intact bone. So it's kind of like screwing a doorknob onto a house door from the outside.

Of course, the whole thing turns out to be a little more complicated with humans, like with a house door, because here nerve tracts and vessels can be injured and permanent damage occurs. Therefore, the screw fixation is always carried out under the control of an X-ray machine. As a rule, a hole is first pre-drilled and a wire pushed forward, which in the X-ray contrasts black against the white bone mass. This ensures that the screw will be in the right place later.
If the hole has been pre-drilled in the right place, a titanium screw is now screwed into the pre-drilling. There is a large number of strengths, diameters and threads that are individually selected by the surgeon for the patient.

Severe fractures, or the combination of a debris fracture and chipping, can make it necessary to supply the elbow fracture with screws and plates at the same time. In any case, the arm must be immobilized for 6-8 weeks.

The immobilization is carried out with a plaster cast and so-called "Gilchrist bandage". This is the name of the bandage that traditionally holds the arm in front of the body at a 90 degree angle and is thrown around the patient's neck.

However, surgery is not always necessary: ​​if the fracture is only minimally displaced or not at all, conservative immobilization may also be sufficient. It is always important to consider how the broken elbow will heal. A shift can still be tolerated up to a small extent, but if the bone pieces are shifted too much, the result is a subsequent malalignment with conservative treatment. Over the years, this causes improper strain on the elbow joint and accelerated wear. Bones and joints are basically the foundation of the elbow. If the statics are disturbed at this point, sooner or later there will be problems in the entire arm.

Read about this too Elbow brace

behavior in case of emergency

Because one Broken elbow is almost exclusively based on a traumatic event, should be referred to at this point emergency care of a broken elbow.

First of all, between open, and closed Fraction can be distinguished.

An open break occurs when the Bones visible through the skin passes through. In the further procedure, this plays a role insofar as the risk of injury to blood vessels is higher with open fractures than with closed ones. Is a strong one Bleeding visible, should be a Printing compound be created. In an emergency it is not important what the bandage looks like, but that it fulfills its purpose. The goal must be to stop the bleeding Pressure on the vessel to stop. This can also be done by simply Raise the arm happen above heart level.

Furthermore, the arm must be immobilized. If there is no bleeding, you can already have one on the way to the hospital cooling to be started. This reduces the flow of blood into the tissue, inhibits swelling and makes the surgeon's work easier later.

The PECH rule: “P” for pause, “E” for ice cream, “C” for compression, and “H” for elevated position.

diagnosis

The diagnosis can be made in the Emergency room relatively easy roentgen and physical exam will be provided.

Safe fracture signs are abnormal mobility, Bone crunching, Axis misalignment, and open Impaling of the skin. The Type of break judge.

Also in the further course is the roentgen The treatment of choice for fractures: surgery, and Aftercare of the elbow fracture always occurs under radiological control.

forecast

The prognosis of the Broken elbow is usually good as long as the break is straightforward.

Because the broken elbow becomes one of the most common types of fractures heard, it is a routine intervention that is carried out thousands of times a year in Germany.

However, it can with Joint involvement, Soft tissue injury or Injury to vessels complications arise. If individual areas of the Elbow are no longer adequately supplied with blood, this can lead to the death of the corresponding areas.

A "wrong" growing together of the bone fragments can lead to a misalignment of the Bone to lead. Even small deviations are sufficient to establish the balance of power in the bone to move. Over the years it can become permanent Incorrect strain on the elbow joint come and as a result to the increased Joint wear.

Sports that the Elbow heavily loaded, may no longer be able to be performed with the same force. This includes tennis, squash, and also Golf. In addition, after 6-8 weeks of rest, the muscle mass on the affected arm has mostly decreased significantly. Therefore, especially in older patients, surgical care is included physical therapy that helps the muscle to build up again in a targeted manner.

prophylaxis

A broken elbow as a result of one Sports accident can be avoided by wearing elbow pads. Especially in sports like inline skating or ice hockey, these should be part of the standard repertoire, especially if you have little practice.

For older patients, it is often sufficient Stumbling blocks such as carpets or objects lying around. Also on a correct attitude of the medication must be respected. Many drugs that are taken frequently with age have an impact on balance and mobility. These include antihypertensive drugs, antidepressants, sleeping pills, and tablets against Travel sickness and allergies.

Complications

A very important nerve runs along the olecranon, the Ulnar nerve. We feel it when we look at the Elbow and we get a sudden, uncomfortable-electrifying feeling.

Will this nerve with Broken elbow, at the Torn ligament on the elbow or injured the subsequent surgery, it can too Numbness come in the area of ​​the ring and little finger.

Also one Restriction of movement can occur in the described area. The ulnar nerve supplies many small ones Muscles and nerve cells on the hand.
Sometimes the paralysis subsides after a few weeks, and sometimes it persists.
Subsequent rehabilitative care must then try to restore the functionality.