Dislocation of the forearm is a displacement of the joints of the radius, ulna and humerus relative to each other. Such an injury is always accompanied by sudden pain, severe swelling and noticeable deformity. In this state, the movement of the victim is limited, that is, the person cannot move the injured limb.
If there is a need to determine the nature of the injury, MRI or CT is used as an auxiliary diagnosis. Treatment of dislocation of the forearm is performed by repositioning it and then fixing the joint with a plaster cast for 2-3 weeks. After removing it, the patient should do restorative therapy: exercise therapy, visits to physiotherapy and massage sessions.
Some information
Trauma of the forearm is the second most common and accounts for approximately 18-22% of the total number of dislocations. Such an injury occurs predominantly in children, often accompanied by a fracture of the bones of the shoulder.
Dislocation can be complete (joints do not touch) or incomplete (joints partially touch). In about 90% of all cases of injury, both bones of the forearm are injured. Isolated dislocations of only one bonevery rare.
In order to understand the features of this injury, you should know exactly how the forearm is formed. The elbow joint is the articular surfaces of the radius, ulna and humerus. It is surrounded by a small capsule, reinforced on the sides with two reliable ligaments.
Varieties
Orthopedists and traumatologists classify dislocation of the forearm (according to ICD-10 - S53), highlighting several types:
- front;
- divergent;
- rear;
- lateral (outward);
- medial (inwards).
In addition, there are also isolated injuries to the radius and ulna.
Posterior dislocation of the forearm
Appears against the background of indirect damage, for example, when falling on an outstretched arm extended at the elbow. The condition is accompanied by rupture of the joint capsule and displacement of the lower part of the shoulder forward. Posterior dislocation of the forearm is often combined with a fracture of the condyles of the shoulder in adults and epicondyles in children.
In this type of injury, patients complain of sudden, sharp pain in the injured area. The hand is forced to bend a little. The joint is deformed, increases in size. The mobility of the elbow is limited, even when trying to do something, the victim feels a typical springy resistance. The front of the forearm looks a little shortened. The olecranon moves backward and upward. In the fold zone, the lower part of the humerus is palpated.
Anterior dislocation
This kind of injuryoccurs quite rarely. The cause of the injury is usually a direct blow to the area of the elbow joint with a bent arm. Such a dislocation is often accompanied by a fracture of the process in this area.
At the moment of damage, the victim feels a sharp pain. During the examination, an abnormal lengthening of the forearm on the injured side, retraction in the area of the process is detected. The mobility of the joint is also limited, and when trying to do something, springy resistance is felt. Although its functionality is preserved to a greater extent than with a posterior dislocation of the forearm.
Side damage
Also quite rare. May be accompanied by injury to the ulnar or median nerve with a characteristic loss of sensation in the region of innervation. Like all other dislocations, lateral injuries are characterized by sharp pain, limited movement in the joint and the presence of spring resistance.
External injury occurs due to direct impact on the elbow from the inside to the outside. Such dislocations are rarely complete. This condition is accompanied by swelling, deformity, abnormal outward displacement of the articular axis.
Internal dislocation of the forearm also occurs against the background of a direct blow. Only in this case it should be directed in the opposite direction - from the outside to the inside. Patients with this diagnosis report severe pain. In this case, the elbow joint is characterized by swelling, deformity, the axis shifted inward.
Symptomatics
Usually dislocation of the forearm (ICD-10 - S53)characterized by the following features:
- sharp sudden pain in a damaged joint;
- severe puffiness;
- not being able to move the injured arm;
- pronounced decrease in sensitivity throughout the limb;
- damage to blood vessels and nerves near the elbow.
Visible symptoms of a dislocation depend on the type of injury. However, in general, the clinical picture is characterized by the described signs and is inherent in all types of injury.
Diagnosis
X-ray examination of a patient with a dislocation of the bones of the forearm must be carried out both before and after reduction. The images show concomitant injuries to the coronoid process, radius, medial epicondyle, and capitate.
Dislocation of the forearm is always accompanied by trauma to the capsular-ligamentous system of the elbow joint. In this case, the lateral ligaments along the bone fragment are damaged. The medial ligament acts as the main stabilizer of the elbow. Provided its integrity, dislocation in the joint does not occur. After repairing the injury, it is imperative to assess the latent instability of the elbow to prevent chronic pathology.
An important role in the early diagnosis of injuries of the capsular-ligamentous system of the joint is played by radiopaque examination. During this procedure, a special contrast agent is injected into the joint cavity. With dislocation of the forearm and,accordingly, damage to the capsular-ligamentous system, the substance used is found in the para-articular tissues. This phenomenon fully confirms the proposed diagnosis.
Treatment of a dislocated forearm
Fixation of the injured hand is necessary as first aid. The optimal length of the tire is from the upper third of the shoulder to the fingertips of the victim. The patient is given painkillers, after which he is transported to the traumatology.
Reduction of dislocations of the forearm is carried out by an orthopedic traumatologist under local anesthesia or general anesthesia. The type of procedure itself depends on the type of injury.
So, to reduce the posterior dislocation, the patient is placed in a horizontal position, and the injured arm is set at a right angle. The doctor stands on the outside of the shoulder and firmly grasps its lower part above the elbow. The assistant should be slightly to the right and take the patient's hand. At the same time, specialists smoothly extend their arms, gently bending the injured joint. The traumatologist, pressing on the olecranon and radial brush, shifts the forearm forward, and the shoulder back. The reduction procedure usually proceeds without any difficulty and is characterized by the occurrence of a click.
In case of an anterior dislocation, the victim is laid on the table and the arm is taken away to a right angle. The assistant fixes and pulls the shoulder in the opposite direction, and the traumatologist flexes the elbow, simultaneously pulling the forearm and pressing the proximal part of the arm downwards.
When a dislocation is detected inside, the patient is laid on the couch and the arm is withdrawn in the same way until a right angle is obtained. One of the assistants fixes and holds the shoulder, the second one stretches the forearm along the axis. The traumatologist presses on the proximal area and at the same time presses on the external condyle in the direction from outside to inside.
In external dislocation, the assistant fixes the shoulder abducted at a right angle, and the doctor stretches the forearm, while pressing on its upper part inwards and backwards.
After reduction, it is necessary to check the pulse in the region of the radial artery, the mobility of the elbow to exclude the possibility of pinching the capsule and instability of the joint. An x-ray should definitely be done. In addition, it is desirable to undergo a contrast arthrogram and an X-ray with a forearm valgus procedure.
After reduction of the posterior or anterior dislocation, the cast is applied for 1-2 weeks. After elimination of lateral damage, the bandage is used for three weeks. After this time, the patient is prescribed physiotherapeutic procedures in the form of electrophoresis, paraffin therapy, SMT and therapeutic exercises.
Isolated dislocations in children
Such injuries are quite rare. Most often, children aged from one to three years are affected. The injury appears due to sudden jerking, pulling on the arm, or trying to hold the baby by the arm at the time of the fall. In this condition, the child usually complains of pain in the areajoint. At the same time, the injured arm is extended along the body, and attempts to bend the elbow are accompanied by pain. You can identify the problem by probing the joint and forearm.
X-ray with such a dislocation gives little information, so it is extremely rare. For reduction, the traumatologist gently pulls the forearm, gradually bending the arm at the elbow and turning the palm down. At the same time, the doctor presses his fingers on the head of the radius. When repositioning, you can hear a characteristic click. This procedure is usually carried out easily, delicately and almost painlessly. Anesthesia is not required, since the reduction brings the child much less discomfort than the dislocation itself.
