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Fractures of the humerus at the site of the ulna formation
Last reviewed: 07.07.2025
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[ Anatomy of the elbow joint
The elbow joint is formed by the humerus, ulna and radius bones, which connect three pairs of articulating surfaces: the humero-ulnar - between the block of the humeral condyle and the lunate notch of the ulna; the humeroradial - between the head of the humeral condyle and the head of the radius; the radio-ulnar - between the head of the radius and the radial notch of the ulna.
The humero-ulnar joint can flex and extend, the range of which is limited by the coronoid process of the ulna in front and the olecranon process of the ulna in the back. The humeroradial joint is more mobile. In addition to flexion and extension, it can rotate outward and inward. Only rotational movements are possible in the radioulnar joint.
All three joints are located in a single closed cavity, limited by the ulnar capsule. The capsule is thickened on the sides by the collateral ulnar and radial ligaments, which attach the humeral condyles to the bones of the forearm. Of the other powerful ligaments of the elbow joint, the annular ligament of the radius should be mentioned, which covers its neck and head without merging with them. It is attached at both ends to the ulna and holds the radioulnar joint like a collar.
The brachial vein and artery pass along the anterior surface of the elbow joint, which at the level of the neck of the radius divides into the radial and ulnar arteries. The median nerve is also located here in the elbow bend area. The ulnar nerve passes along the posteromedial surface of the elbow joint, bending around the internal epicondyle.
The blood supply to the elbow joint is provided by a network formed by the branching of the brachial artery. The joint capsule is innervated by the median, radial and ulnar nerves.
Humeral condyle fractures
Damage to the following sections that make up the humeral condyle is possible: the internal and external epicondyles of the humerus, the head of the humeral condyle, the block, and the condyle itself in the form of linear T- and Y-shaped fractures.
Fractures of the epicondyles of the humerus
Fractures of the epicondyles of the humerus are classified as extra-articular injuries and most often occur in children and adolescents.
The mechanism of injury is indirect - excessive deviation of the forearm inwards or outwards (avulsion fractures), but it can also be direct - a blow to the elbow joint or a fall on it. The internal epicondyle of the humerus is most often affected.
Symptoms and diagnosis of a fracture of the humeral epicondyles
History, examination and physical examination. The patient is concerned about pain at the site of injury. Swelling and bruising are also visible here. Palpation reveals pain, sometimes a mobile bone fragment, and crepitus. The external landmarks of the joint are disturbed. Normally, the protruding points of the epicondyles and the olecranon form an isosceles triangle when the forearm is bent, and when the elbow joint is extended, the points diverge, forming a straight line - a triangle and Huther's line. Displacement of the epicondyle leads to deformation of these conventional figures. Movements in the elbow joint are moderately limited due to pain. For the same reason, but more pronounced, there is a limitation of rotational movements of the forearm and flexion of the hand in case of a fracture of the internal epicondyle and extension of the hand in case of an injury to the external epicondyle of the humerus.
Laboratory and instrumental studies. The diagnosis is summarized by radiography of the elbow joint in direct and lateral projections.
Treatment of humeral epicondyle fracture
In case of fractures without displacement or in cases where the fragment is located above the joint space, conservative treatment is used.
After procaine blockade of the fracture zone, the limb is immobilized with a plaster cast from the upper third of the shoulder to the heads of the metacarpal bones with the forearm positioned between supination and pronation. Elbow flexion is 90°, the wrist is extended at an angle of 30°. The immobilization period is 3 weeks. Then rehabilitation treatment is prescribed.
If significant displacement of the fragment is detected, closed manual reposition is performed. After anesthesia, the forearm is deflected toward the fractured epicondyle and the fragment is pressed to the maternal bed with the fingers. The forearm is bent to a right angle. A circular plaster cast is applied from the upper third of the shoulder to the heads of the metacarpal bones for 3 weeks, then the cast is made removable for 1-2 weeks. Restorative treatment is prescribed.
Surgical treatment. Sometimes, when the forearm is dislocated, the medial epicondyle is torn off and pinched in the joint cavity. This is why, after the forearm is repositioned, the elbow joint functions are not restored (joint "block") and pain syndrome persists. The X-ray shows a pinched epicondyle of the humerus. Urgent surgery is indicated. The elbow joint is opened from the inside, exposing the area of the epicondyle torn off. The joint space is opened by tilting the forearm outward. The pinched bone fragment with the muscles attached to it is removed with a single-tooth hook. This manipulation should be carried out very carefully, since the epicondyle can become pinched with the ulnar nerve. The torn bone fragment is fixed to the maternal bed with a pin, a screw, and in children, the epicondyle is sewn with transosseous catgut sutures. The periods of immobilization are the same as for conservative treatment.
Approximate period of disability. In case of fractures without displacement, the ability to work is restored in 5-6 weeks. In other cases, return to work after a fracture of the lateral epicondyle of the humerus is allowed in 5-6 weeks, and of the internal epicondyle - in 6-8 weeks.
Fractures of the head of the condyle and trochlea of the humerus
Fractures of the head of the condyle and the trochlea of the humerus, as separate nosological forms of injury, are very rare.
Symptoms and diagnosis of fracture of the head of the condyle and trochlea of the humerus
History, examination and physical examination. The fractures are intra-articular, which determines their clinical picture: pain and limitation of the elbow joint functions, hemarthrosis and significant swelling of the joint, a positive symptom of axial load.
Laboratory and instrumental studies. The diagnosis is confirmed by radiography.
Treatment of fracture of the head of the condyle and trochlea of the humerus
Conservative treatment. In case of fractures without displacement, puncture of the elbow joint is performed, hemarthrosis is eliminated and 10 ml of 1% procaine solution is administered. The limb is fixed with a plaster cast in a functionally advantageous position from the upper third of the shoulder to the metacarpophalangeal joints for 2-3 weeks. Then they begin to develop movements, and immobilization is used as removable for another 4 weeks. Restorative treatment continues after the plaster cast is removed.
In case of fractures with displacement, closed manual reposition is performed. After anesthesia, the arm is extended at the elbow joint, traction is created along the longitudinal axis for the forearm and hyperextended, trying to maximally widen the gap of the elbow joint. The torn fragment, usually located on the anterior surface, is reduced by the surgeon using the pressure of his thumbs. The limb is bent to an angle of 90° with the forearm pronated and fixed with a plaster cast for 3-5 weeks. Active therapeutic gymnastics is prescribed, and immobilization is maintained for another month.
Surgical ligation. If closed alignment of fragments is impossible, open reposition and fixation of fragments with Kirschner wires are performed. It is necessary to insert at least two wires to exclude possible rotation of the fragment. The limb is immobilized with a plaster cast. The wires are removed after 3 weeks. From this time, immobilization is converted to removable and maintained for another 4 weeks. In case of multi-comminuted fractures, good functional results are obtained after resection of the crushed head of the humeral condyle.
Approximate period of disability. In case of fractures without displacement, the working capacity is restored in 8-12 weeks. In case of fractures with displacement followed by conservative treatment, the period of disability is 12-16 weeks. After surgical treatment, the working capacity is restored in 10-12 weeks.
Linear (marginal), T- and Y-shaped fractures of the humeral condyle
Such fractures are complex intra-articular injuries that can result in limitation or loss of elbow joint function.
The mechanism of injury may be direct or indirect.
Symptoms and diagnosis
Symptoms are characterized by pain, loss of limb function, significant swelling and deformation of the elbow joint. The triangle and Huther's line, Marx's sign are impaired and in some cases not determined. The diagnosis is clarified by radiography.
Treatment
Conservative treatment. In case of fractures without displacement of fragments, treatment consists of eliminating hemarthrosis and anesthetizing the joint. The limb is fixed with a trough-shaped plaster splint from the upper third of the shoulder to the heads of the metacarpal bones. The forearm is flexed to an angle of 90-100° and given an average position between supination and pronation. After 4-6 weeks, immobilization is converted to removable for 2-3 weeks. Complex treatment is prescribed. Resumption of work is allowed after 8-10 weeks.
Treatment of fractures with fragment displacement is reduced to closed reposition. It can be either one-stage manual or gradual using skeletal traction for the olecranon or an external fixation device. The main thing is that the restoration of the anatomical relationships of bone fragments should be as accurate as possible, since inaccurate alignment and excess bone callus grossly disrupt the functions of the elbow joint. The repositioning technique is non-standard, its stages are selected individually for each specific case. Its principle consists of traction for the forearm bent at a right angle in order to relax the muscles, deflecting the forearm outward or inward to eliminate angular displacement, modeling (elimination of displacement in width). The forearm is placed in a middle position between supination and pronation.
It is better to use general anesthesia. Successful alignment of the fragments, confirmed by X-ray control, is completed by applying a plaster splint from the shoulder joint to the heads of the metacarpal bones with flexion at the elbow joint to 90-100 °. A lump of loosely laid cotton wool is placed in the elbow bend area. Tight bandaging, constrictions in the joint area should be excluded, otherwise the increasing edema will lead to compression and the development of ischemic contracture. The period of permanent immobilization is 5-6 weeks, removable - another 3-4 weeks.
Surgical treatment is used when conservative attempts at alignment are unsuccessful. Open reposition is performed as sparingly as possible. The joint capsule and muscles must not be separated from the bone fragments. This will lead to nutritional disorders and aseptic necrosis of bone areas. The aligned fragments are fixed in one of the ways.
After suturing the wound, the limb is fixed with a plaster splint, the same as in conservative treatment. The period of permanent immobilization is 3 weeks, removable - 4 weeks.
Approximate period of disability. In a favorable outcome, working capacity is restored within 10-12 weeks from the moment of injury.