Dislocation of the forearm is the 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 marked deformation. In this condition, the movements of the victim are limited, that is, a person cannot move a damaged 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 carried out by means of its reduction and subsequent fastening of the joint with a plaster cast for 2-3 weeks. After its removal, the patient should take up rehabilitation therapy: exercise therapy, visiting physiotherapy and massage sessions.
A little information
Injury of the forearm takes second place in frequency and is approximately 18-22% of the total number of dislocations. Such damage occurs mainly in children, often accompanied by a fracture of the bones of the shoulder.
A dislocation is complete (joints are not touching) and incomplete (joints are partially touching). In approximately 90% of all injuries, both forearm bones are injured. Isolated dislocations of only one bone are very rare.
In order to understand the features of this injury, you should know 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, fortified on the sides with two reliable ligaments.
Varieties
Orthopedists and traumatologists classify the dislocation of the forearm (according to ICD-10 - S53), identifying several types:
- front;
- divergent;
- rear;
- lateral (outside);
- medial (inside).
In addition, there are also isolated injuries of the radius and ulna.
Rear forearm dislocation
Appears against the background of indirect damage, for example, when falling onto an elongated arm, extended at an elbow. The condition is accompanied by a rupture of the joint capsule and a shift of the lower part of the shoulder forward. The posterior forearm dislocation is often combined with a fracture of the condyles of the shoulder in adults and epicondyle in children.
With such an injury, patients complain of sudden sharp pain in the damaged area. The hand is forced to bend a little. The joint is deformed, increases in size. The mobility of the elbow is limited, when trying to even do something, the victim feels a typical spring resistance. In front, the forearm looks a little shortened. The ulnar process moves posteriorly and upward. In the bend zone, the lower humerus is palpated.
Front dislocation
This type of injury is quite rare. The cause of the damage is usually a direct blow to the elbow joint area with the arm bent. Such a dislocation is often accompanied by a fracture of the appendix in this area.
At the time of injury, the victim feels a sharp pain. During the examination, an abnormal elongation of the forearm from the damaged side is detected, a retraction in the process zone. The mobility of the joint is also limited, and when trying to do something, a springy resistance is felt. Although its functionality is preserved to a greater extent than with the rear dislocation of the forearm.
Side damage
They are also quite rare. May be accompanied by injury to the ulnar or median nerve with a characteristic loss of sensitivity in the innervation area. Like all other dislocations, lateral injuries are characterized by sharp pain, restriction of movements in the joint and the presence of spring resistance.
External injury occurs due to a direct effect on the elbow from the inside to the outside. Such dislocations are rarely complete. This condition is accompanied by swelling, deformation, an abnormal displacement of the articular axis outwards.
An internal dislocation of the forearm also occurs against the background of a direct impact. Only in this case should it be directed in the opposite direction - from outside to inside. Patients with this diagnosis have a sharp pain. In this case, the elbow joint is characterized by swelling, deformation, displaced axis inward.
Symptomatology
Usually a dislocation of the forearm (according to ICD-10 - S53) is characterized by such signs:
- acute sudden pain in a damaged joint;
- severe swelling;
- lack of ability to move an injured hand;
- pronounced decrease in sensitivity throughout the limb;
- damage to blood vessels and nerves near the elbow.
The visible symptoms of dislocation depend on the type of damage. However, in general, the clinical picture is characterized by the described symptoms and is inherent in all types of injury.
Diagnostics
An X-ray examination of a patient with a dislocation of the bones of the forearm must be carried out both before and after reduction. In the pictures, you can consider the accompanying damage to the coronoid process, radius, medial epicondyle and capitate elevation.
Dislocation of the forearm is always accompanied by trauma to the capsular-ligamentous system of the elbow joint. In this case, the lateral ligaments are damaged along the bone fragment. The medial ligament acts as the main stabilizer of the elbow. Given its integrity, dislocation in the joint does not occur. After eliminating the trauma, it is imperative to evaluate the latent instability of the elbow to prevent chronic pathology.
An important role in the early diagnosis of injuries of the capsule-ligamentous joint system is played by radiopaque examination. During this procedure, a special contrast agent is injected into the joint cavity. With a dislocation of the forearm and, accordingly, damage to the capsule-ligamentous system, the substance used is found in paraarticular tissues. This phenomenon fully confirms the alleged diagnosis.
Forearm Dislocation Treatment
As first aid, it is necessary to fix the injured hand. The optimum tire length is from the upper third of the shoulder to the victim’s fingertips. The patient is given painkillers, after which he is transported to traumatology.
Reduction of forearm dislocations is carried out by an orthopedic trauma specialist under local anesthesia or general anesthesia. The type of procedure itself depends on the type of injury.
So, to reposition the posterior dislocation of the patient, they are placed in a horizontal position, and the damaged arm is set at right angles. The doctor stands on the outside of the shoulder and tightly grasps its lower part above the elbow. The assistant should be a little to the right and take the patient’s brush. At the same time, specialists smoothly extend their arms, gently bending the injured joint. The traumatologist, clicking on the ulnar process and the radial hand, shifts the forearm forward, and the shoulder back. The reduction procedure usually takes place without any difficulties and is characterized by the appearance of a click.
With a front dislocation, the victim is laid on the table and the arm is taken to the right angle. The assistant makes a fixation and extends the shoulder in the opposite direction, and the traumatologist bends the elbow, while pulling the forearm and pressing the proximal portion of the arm in a downward direction.
If a dislocation is found inside the patient, they are laid on the couch and in the same way they take their hand away to obtain a right angle. One of the assistants fixes and holds the shoulder, the second - extends the forearm along the axis. The traumatologist presses on the proximal section and at the same time presses on the external condyle in the direction from the outside to the inside.
With an external dislocation, the assistant fixes the shoulder allotted at a right angle, and the doctor extends the forearm, while pressing on its upper part inwards and backwards.
After reduction, it is necessary to check the pulse in the area of the radial artery, elbow mobility to exclude the possibility of pinching the capsule and joint instability. You should definitely take an x-ray. In addition, it is advisable to undergo a contrast arthrogram and radiograph with the procedure of valgating the forearm.
After reduction of the posterior or anterior dislocation, gypsum is applied for 1-2 weeks. After repair of lateral injuries, the dressing 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 injured. Injury occurs due to sudden jerking, pulling on the hand or trying to hold the baby by the hand at the time of the fall. In this condition, the child usually complains of pain in the joint area. In this case, a damaged 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.
An x-ray with such a dislocation gives little information, so it is extremely rare. To reposition, 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 radial head. When setting, you can hear a characteristic click. Such a procedure is usually carried out easily, delicately and almost painlessly. In this case, anesthesia is not required, since the reduction brings the child much less discomfort than the dislocation itself.