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Fracture of the ulnar process: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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What causes fracture of the elbow process?
Fracture of the elbow often occurs from a direct mechanism of injury (for example, falling on the elbow), but it can also happen with indirect violence - a break from a sharp contraction of the triceps or a fall on the wrist of the elbow in the elbow joint.
Symptoms of fracture of the ulnar process
The patient complains of pain and impaired function of the joint.
Diagnosis of fracture of the ulnar process
Anamnesis
Examination and physical examination
The contours of the joint are smoothened by edema and hemarthrosis. When palpation is noted sharp soreness in the fracture zone, in case of displacement of fragments, a slit-like incision is observed, going transversely to the long bone. The triangle and the Poter line are broken. Movement in the elbow joint is limited due to pain. In fractures with displacement, the active extension is predominantly affected, since the trigeminal muscle of the shoulder is included.
Laboratory and instrumental research
Confirm the diagnosis by radiography in two projections, with the lateral performed with a bent elbow joint.
Treatment of fracture of the ulnar process
Indications for hospitalization
In polyclinic and home conditions, fractures of the elbow process are treated without displacement of the fragments.
Conservative treatment of fracture of the ulnar process
With a fracture of the elbow process without displacement of the fragments, 10 ml of 1-2% procaine solution is injected into the fracture site. The elbow joint is bent at an angle of 90-100 °, the forearm is set in the position, the middle one is between supination and pronation, the hand is in a functionally advantageous position. The achieved position is fixed with a gypsum longus from the upper third of the shoulder to the metacarpophalangeal joints for a period of 3 weeks. Then they start restorative treatment, and transfer the gypsum longite into a removable one for another 1-2 weeks.
Hospitalization is subject to patients with comminuted fractures and fractures with a divergence of fragments.
With comminuted fractures and fractures with divergence of fragments, the surgeon's tactics are as follows. Under local anesthesia, a closed manual reposition in the elbow position of the elbow joint is performed to relax the muscles. If the reposition is successful, the limb can be immobilized in a functionally unfavorable position (undone) by a posterior gypsum lint for 4-5 weeks. Then they proceed to restorative treatment, and immobilization is transferred to a removable one for another 1-2 weeks.
Surgical treatment of fracture of the ulnar process
Unmatched fracture of the ulnar process disrupts congruence and leads to a severe restriction of the functions of the elbow joint, so it is necessary to reposition the open method. With preserved fracture of fragments of 0.5 cm and more, surgical treatment is also indicated. A fragment of the elbow process is fixed to the bed with a suture (silk, wire) or with a long screw, which must necessarily perforate the cortical layer of the anterior surface of the ulna. It is even better that it is additionally fixed with a wire loop carried transversely through the ulna, like a wire loop in the Weber operation. In recent years, we have made loops from a slowly dissolving, durable suture material, which eliminates re-intervention.
Osteosynthesis of the elbow process is also possible with plates. Osteosynthesis should be stable, do not require external immobilization, and provide the ability to perform movements immediately after surgery in the elbow joint.
In multi-lobed fractures, all bone fragments are removed, and the tendon of the triceps muscle is fixed to the ulna.
The limb is immobilized with a gypsum longus in the flexion position in the elbow joint at an angle of 90-100 ° for 4 weeks continuously and for 1-2 weeks keep removable. Labor is possible in 8-10 weeks. The metal fixator is removed after 12 weeks from the moment of intervention after the detection of fusion by radiography.
Estimated period of incapacity for work
Workability is restored in 6-8 weeks. In other cases, work is allowed after 8-10 weeks.
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