What are Arm Fractures?
An arm fracture is a broken or cracked bone in any of the three bones that construct the arm. The humerus is the bone in the upper arm between shoulder joint and the elbow joint. There are two bones of the forearm: the radius and the ulna. They are located between the elbow joint and the joints of the wrist. When standing in anatomical position (arms at sides and palms facing forward) the ulna is the bone closest to the body and the radius is closest to the thumb.
These three bones can be broken in many ways. The fracture can be open, whereby the sharp edges of the fractured bone lacerate the skin and may stick out of the wound; or closed, leaving the skin is intact. The fracture may be comminuted, meaning that the bone has broken into several small pieces. The fracture may be associated with a dislocation, where the bone has come out of alignment with the joint. A fracture may also be described as displaced, meaning that the ends of the bone no longer line up. A greenstick fracture occurs when only one side of a long bone is broken.
What are the causes of Arm Fractures?
Arm fractures generally occur as a result of trauma. They commonly occur by falling onto an outstretched hand. They can be caused by a direct blow to the arm like being hit with an object like a baseball bat or in an automobile accident. A crush injury to the arm can also result in fracture.
A pathologic fracture occurs in bones that are inherently weak. This can be due to a previously undiagnosed congenital deformity of the bone, an occult tumor of the bone, or a medical condition that causes weakness of the bone like osteoporosis or long term use of corticosteroids.
A spiral fracture of the arm is caused by rotation along with muscle contraction of great force, and the resulting crack wraps around the bone in a spiral fashion. This type of injury is rare and is sometimes called ball-thrower’s fracture.
What are the symptoms of Arm Fractures?
Arm fractures usually cause immediate onset of pain and swelling. Depending on the type of fracture, there may be lacerations of the skin with bone fragments sticking out. The arm may appear obviously deformed or crooked and need to be supported with the other arm. The affected arm may be shorter than the other due to displacement or dislocation. Range of motion may be severely limited. If nerve damage has occurred there may be numbness, tingling, or weakness. If damage to the underlying blood vessels has occurred there may be bruising, bleeding, or the hands may appear cyanotic, or blue.
How are Arm Fractures diagnosed?
A careful history including the details of the traumatic event usually points to the diagnosis of a fracture. The physical exam will also reveal clues and will check for the presence of foreign bodies in the wound (if present), and assess whether the nerves and blood vessels in the area of injury are intact. Imaging studies are essential to the diagnosis of a fracture. X rays are used to examine the arm bones for the exact location and type of fracture sustained. Sometimes a fracture is not immediately visible on X rays. These occult fractures are usually tiny cracks causing pain and disability without displacement of the bones or joints. CT or MRI must be used to diagnose fractures in these cases.
How are Arm Fractures treated?
Depending on the severity of the arm fracture, non surgical or surgical methods may be employed to treat the fracture.
If only one bone is broken and it is not displaced, immobilizing the bone in a cast or splint may be all that is needed for the bone to heal itself. Serial X rays will be ordered to make sure that the bone remains in proper alignment throughout the healing process.
If the fracture causes the bones to come out of alignment, it may be possible for a physician to temporarily re-align the bones by reducing the fracture. This commonly occurs in the Emergency Department. In reduction, pain medication is given and the physician manually attempts to re-align the bones. The arm is then immobilized in a splint and a follow up appointment with an Orthopedic Surgeon is made for the following day.
If nerves or blood vessels of the arm are damaged, or if an open fracture is present, emergent surgical treatment is warranted. Emergent surgical treatment may also be needed if a fracture extends into a joint or if the fracture cannot be stabilized by reduction and/or splinting.
Most surgical treatment of arm fractures may be done in a timely, but non emergent fashion. If the skin is not broken, it may be advisable to give the splinted arm a few days for the swelling to go down and then attempt surgical repair.
In a procedure called Open Reduction with Internal Fixation surgical repair is achieved by using rods, pins or plates placed into the bones to hold them in proper position while the bones grow back together.
With External Fixation severe fractures can be stabilized from the outside with a metal brace which wraps around the affected part of the arm. This device, called a fixator, attaches the brace directly to bones of the arm via long screws inserted through the skin and the muscles of the arm to hold the bones in place while they heal.
Following surgery, immobilization is typically maintained for a period of 6 weeks, but this can vary depending on the type of fracture, the age of the individual, and the individual’s state of health. Physical therapy follows once the cast or fixator is removed. This helps to return strength to the muscles of the arm which have atrophied during immobilization. Physical therapy is usually lasts for a period of six months.
How can Dr. Knight help your arm fractures?
Dr. Knight will quickly diagnose your arm fracture and relieve your pain while stabilizing your fracture in a splint or cast and expediting surgical intervention if needed to restore fracture alignment. Upon fracture healing, he will get you the rehabilitation you need to return to an active liefestyle as soon as possible.
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