Forearm dislocation

Description:

Traumatic dislocations and incomplete dislocations of a forearm on frequency take the second place after dislocations of a shoulder and make 18-27%. They are observed more often at men of 10-30 years and women have 50-70 years.

Forearm dislocation reasons:

Dislocations and incomplete dislocations of a forearm result from a direct and indirect injury. The variety of the found dislocations in an elbow joint is explained by complexity of its anatomic structure.

Pathogeny:

Distinguish dislocations of bones of a forearm of a kzada, kpereda, knaruzha, knutra; dislocations and incomplete dislocations of a head of a beam bone of a kpereda, kzada and knaruzha; the diverging forearm dislocation. Carry cases when between joint surfaces the partial contact remains to incomplete dislocations.

The current and outcome of dislocation or incomplete dislocation of a forearm depend not only on size in the form of shift, but also on the nature of damage of the soft tissues surrounding it. Usually dislocation of a forearm is accompanied a hematoma, by damages of the capsular and copular device, muscles, periosteums and in certain cases a prelum of vessels and nerves. Damages of soft tissues are in direct dependence on size and the direction of the operating force. These can explain that fact why the same type of dislocation at different patients proceeds and comes to an end far not equally.

Forearm dislocation symptoms:

Most often (90%) posterior dislocations of a forearm meet. According to experimental data, they arise when falling on the hand which is slightly bent in an elbow joint. At increase in abduction of a forearm side sheaves are considerably injured. Separations of a medial sheaf with a fragment of a medial epicondyle or a coronal shoot are possible, children have an epiphysiolysis of a medial epicondyle. Changes of a head of a beam bone, a capitate eminence or a lateral epicondyle of a shoulder are a consequence of srezyvayushchy compression forces in a humeroradial joint. At posterior dislocation more often than at other types, there are injuries of beam, median and elbow nerves, a humeral artery, the humeral muscle is considerably injured.

At dislocation of a forearm of a kzada at the expense of its shift in the proximal direction an impression of shortening of a forearm and lengthening of a shoulder is made. The axis of a forearm is rejected (more often than a knaruzha) in relation to a shoulder axis. The elbow shoot will stand kzad, its top is displaced up and there is higher than the level of condyles of a shoulder. It distinguishes dislocation from an epicondylic fracture of a shoulder at which Gyuter's triangle formed by a top of an elbow shoot and both epicondyles of a humeral bone is not broken.

Dislocations of a forearm of a kpereda meet less often (about 4,5%). They arise when falling on most bent elbow joint. At front dislocation on site of an elbow shoot retraction is noted, the forearm seems extended in comparison with a forearm of a healthy hand. Damage to a greater or lesser extent of both side linking of front and back departments of the capsule of a joint is characteristic of this type of dislocation. Injuries of a sinew of a tricipital muscle of a shoulder, separations of the muscles which are attached on shoulder condyles are possible.

Lateral and medial dislocations of a forearm meet very seldom. The elbow joint at the same time is expanded in the cross direction. The axis of a forearm is displaced according to knaruzh or knutr. These types of dislocations of a forearm are often combined with a change of a medial or lateral epicondyle of a humeral bone, a head of a beam bone.

Extremely seldom there is a diverging dislocation. It occurs at discrepancy of elbow and beam bones back, forward, knutr or knaruzh, is a consequence of the brute operating force. Not only the capsular and copular device of an elbow joint, but also an interosseous membrane is damaged.

Diagnosis:

Diagnosis of dislocation of a forearm usually does not cause difficulties. Patients are disturbed by forced position of an extremity, impossibility of movements in an elbow joint, severe pains in it. In all cases there is a deformation of an elbow joint depending on a type of dislocation, puffiness of this area is expressed. In attempt to make the passive movements the symptom of "elastic mobility" comes to light.

Radiological inspection of patients with dislocations of a forearm is obligatory before reposition and after it. On roentgenograms of an elbow joint the accompanying changes of a coronal shoot, a head of a beam bone, a capitate eminence or a medial epicondyle are defined.

Dislocations of a forearm are followed by damage of the capsular and copular device of an elbow joint. Side sheaves at the same time are injured on an extent or with a separation of a bone fragment. The main stabilizer of an elbow joint is the medial sheaf. At its integrity of dislocation in an elbow joint does not occur. After elimination of dislocation of a forearm it is necessary to define latent instability of an elbow joint for prevention of chronic instability.

Big help in early diagnosis of damages of the capsular and copular device of an elbow joint is given by a X-ray contrast research at which enter a contrast agent into a cavity of a joint (Verografinum, Urografinum). With defect of the capsular and copular device a contrast agent is defined in para-articular fabrics.

Treatment of dislocation of a forearm:

Elimination of dislocation of a forearm in fresh cases is made or under local anesthesia with introduction of 20-25 ml of 2% of solution of novocaine to a cavity of a joint or under anesthetic. Reposition of dislocation under the general anesthesia is more preferable in connection with the best relaxation of surrounding muscles to prevention of an additional injury of the capsular and copular device and a joint cartilage.

Reposition of posterior dislocation of a forearm. The patient is stacked on a back, the sore hand is taken away from a trunk to a right angle. The surgeon becomes knaruzh from the taken-away shoulder and clasps with both hands the lower part of a shoulder over an elbow joint, puts thumbs of hands on an elbow shoot and a head of a beam bone. The assistant becomes on the same side more to the right of the surgeon and one hand takes the patient's brush, and another - the lower part of a forearm. The surgeon and the assistant make smooth arm extension at simultaneous bending it in an elbow joint. The surgeon, pressing on an elbow shoot and a head of a beam bone, shifts a kpereda forearm, and a kzada shoulder. Reposition usually is done with little effort, at the same time there is a clicking sound.

At posteroexternal dislocation of a forearm the surgeon a thumb makes pressure upon an elbow shoot and a head of a beam bone not only a kpereda, but also knutra.

Reposition of front dislocation of a forearm. The patient is stacked on a dressing table, the hand is taken away to a right angle. The assistant carries out fixing and countertraction of a shoulder, and the surgeon, tightening for a forearm one hand and pressing on a proximal part of a forearm in the direction from top to bottom, knaruzh and kzad other hand, are bent by a forearm in an elbow joint.

Reposition of dislocation of a forearm of a knutra. The patient is stacked on a table, the shoulder is taken away to a right angle. One assistant fixes and holds a shoulder, another carries out extension for a forearm on an axis. The surgeon one hand presses on a proximal part of a forearm from within a knaruzha, and other hand at the same time presses on an outside condyle of a shoulder outside inside.

Reposition of outside dislocation. The assistant fixes the taken-away shoulder, and the surgeon one hand makes extension for a forearm, another presses on an upper part of a forearm of a knutra and a kzada, bending an elbow joint.

After elimination of dislocation of a forearm it is necessary to check pulse on a beam artery, the movements in a joint for an exception of infringement of the capsule, side stability of a joint. Radiological inspection is obligatory: standard roentgenograms, contrast artrogramma and roentgenograms with a forearm valgirovaniye.

If the joint is stable or instability of the I degree is established, conservative treatment is shown. The immobilization is carried out by the plaster splint imposed from a shoulder to metacarpophalangeal joints when bending an elbow joint at an angle 90 °, on average between pronation and supination situation for a period of 2-3 weeks depending on data of a X-ray contrast research.

From the very first days the patient is recommended to carry out the active movements by brush fingers that promotes a rassasyvaniye of hypostasis and hemorrhage in an elbow joint. From the 2-3rd day the isometric tension of the muscles surrounding an elbow joint begin.

After removal of a plaster splint carry out recovery treatment.

The indication to operational treatment is side instability of an elbow joint of the II-III degree. At the same time carefully take in the side capsular and copular device, on the capsule of front and back departments put rare stitches. The term of an immobilization is defined depending on extensiveness of damage of the capsular and copular device, age and the victim's profession.

Treatment of dislocation of a forearm with a separation of a medial epicondyle of a shoulder. In the absence of epicondyle shift after elimination of dislocation of a forearm treatment conservative. Shift of an epicondyle is more than 2 mm and its possible infringement in a cavity of a joint are indications to an operative measure. In this case the epicondyle or its fragment are taken from a cavity of a joint and depending on size fixed the screw, spokes or chreskostny mylar seams. Take in interligamentarny gaps.

Treatment of dislocation of a forearm with a change of a coronal shoot. Consider the size of the torn-off fragment and stability of a joint. If the joint is stable, after elimination of dislocation of a forearm carry out conservative treatment. With side looseness in order to avoid development of chronic instability surgical treatment is shown. Intervention is carried out through anteromedial access. At the big sizes of a fragment of its coronal shoot together with the medial sheaf which is attached to it fix to the basis two - three chreskostny mylar seams or the screw. Fragments of the small sizes delete, hem a sheaf chreskostny seams.

Treatment of dislocation of a forearm with a change of a head of a beam bone. At changes of a head and a neck of a beam bone without shift after elimination of dislocation of a forearm carry out conservative treatment. If there is a shift of a head or its fragment, the resection of the broken head or removal of a fragment in the next 1-3 days after damage is shown. In this case careful sewing up of the damaged capsular and copular device is very important.