Common fractures in the arm/elbow/forearm region are:
• Broken arm (humerus)
• Fracture of the olecranon (bony bump on the back of the elbow)
• Fracture of the radial head (top portion at the elbow joint of one of the forearm bones)
• Forearm fracture (radius or ulna)
1) Broken Arm
Falling on an outstretched arm or being in a car crash are common causes of a broken arm. At the time of injury a loud crack is usually heard. There is extreme pain at the site of injury and the arm may appear deformed and there may be bruising, swelling and bleeding. There will be loss of normal use of the arm and pain will be increased with movement of the arm.
2) Fracture of the olecranon
The olecranon is the bony protuberance on the back of the elbow. Because it has only a thin layer of skin protection it is easily fractured when there is a direct blow to the elbow or if one falls on a bent elbow. There will be immediate pain at the olecranon that increases with elbow movement, swelling and tenderness, possible abrasion/cut of the skin, numbness in one or more of the fingers and deformity if dislocation of the elbow has also occurred.
3) Fracture of the radial head
The radial head is the top portion of the radius (a forearm bone). It is commonly fractured when a large force is pushed through the shaft of the radius to the radial head at the elbow joint such as when you fall on an outstretched arm. Another instance that the radial head may become fractured is when a dislocated elbow is put back into place. In this case the arm bone (humerus) as it goes back into position may chip off a piece of bone resulting in a fracture. If a radial head fracture has occurred there will be pain and swelling on the outside of the elbow. There will be an inability to bend the elbow and to rotate from the elbow.
4) Forearm fractures (radius or ulna)
Forearm fractures are quite common in children. A forearm fracture can occur at any region of the forearm bones and in children can involve the growth plate of the bone. Typically a child has fallen on an outstretched arm resulting in a fracture in one or both of the forearm bones. There will be immediate swelling and pain. There may also be deformity at the elbow, wrist or in the forearm depending on the site of the fracture. Movement will increase pain and there will be an inability to rotate the forearm.
Diagnosis and medical management
As with all suspected fractures and x-ray is always done. The x-ray will allow your doctor to assess the damage to the bone. Management will depend on the presence of a fracture and its severity. Fractures can be classified in many ways. The following is one form of classification:
• Type I fractures are generally stable with little displacement. These fractures can generally be treated non-surgically
• Type II fractures are the most common. They are relatively stable, although there is some displacement of the bone pieces.
• Type III fractures are displaced, there may be many fragments and there is usually significant damage to the soft tissues.
A broken arm is usually reduced (put back into place) by the doctor. In the case of a severe injury surgery may be required. Following the fracture being reduced it will be immobilized in a cast for a period determined by the doctor.
Fracture of the olecranon and radial head
Generally a type I fracture will involve the wearing of a splint and sling with gentle motion allowed early on.
Type II fractures are usually surgically repaired through fixation or removal of the bony pieces. Generally physiotherapy will commence a few days following surgery.
Type III fractures are always surgically corrected through fixation and/or removal of bony pieces. A splint may be worn post surgery and physiotherapy is commenced a few days after surgery.
In most cases the fracture will be set back into place and then put into a cast for immobilization for a period of time determined by the doctor. In type II and III fractures surgery is usually required to reset the bones and then fixate them. Depending on what part of the forearm has been fractured and in which way will determine whether further immobilization in a cast is required or if mobilization (movement) is to be commenced. If the growth plate was involved then careful monitoring for several years will most likely be done by your physician.
Physiotherapy would commence according to the doctor’s instruction. In most cases initial physiotherapy would involve reducing pain and inflammation and beginning gentle movement. This may include the use of electrotherapeutic modalities, gentle range of motion exercise, gentle soft tissue techniques and maintenance exercises for other nearby joints. As the fracture continues to heal physiotherapy would move onto gaining full range of motion and strength through the use of more vigorous treatments and exercise. As with all fractures it takes a long time before sport can be recommenced as it is important to allow healing to occur. Your physiotherapist however will be able to guide you in a gradual and safe return to sport/activity.