Arm fracture

Overview of arm fracture

The arms are the most vulnerable parts of the body which may be subjected to repeated mechanical trauma and injuries. Most of these injuries are the sports injuries and the rest also arise from some forms of overuse. The International Osteoporosis Foundation has shown that distal forearm fractures are very common in the people above 65 years old. Around 44% of these cases comprised of the radius and ulna fractures. Arm fractures are common in children and young adults as well. Proper diagnosis and treatment are necessary for the complete recovery of these patients. Failure to do so may result in a permanent deformation of the affected bones.

What is arm fracture?

Arm fracture is defined as the discontinuity in the bones of an arm or a portion of the arm due to overuse injury, mechanical trauma or certain chronic diseases. It mainly arises from a high-force impact or stress. It may also arise from certain bone diseases like osteoporosis, osteogenesis imperfecta or bone cancer. In those cases, arm fracture is also known as pathogenic arm fracture. Single or multiple bones of the fore, middle or upper arm may be affected due to these types of fractures. The different types of arm fractures will be discussed in details under the upcoming subheadings.

What are some of the causes of arm fracture?

Some of the commonly studied causes of arm fracture are given below-

• Mechanical injury due to overuse
• Trauma caused by accidental injuries (car accident, fall from a height)
• Repeated stress and strain
• Improper striking techniques in sports
• Occupational hazards such as lifting heavy loads on a regular basis
• Change in structures and properties of the bones of the arms
• Deficiency of essential vitamins and minerals

When do you know that an arm fracture has occurred?

An arm fracture usually presents as-

• Swelling and pain the affected portion
• Breaks in the periosteum and endosteum
• Bluish or purplish discoloration of the affected regions
• Swelling and edema of the soft tissues
• Intense pressure pain
• Bleeding of the periosteal blood vessels
• Muscle pain, spasms, and cramps
• Damage to the structures close to the affected bones such as blood vessels and nerves
• Inability or pain in moving the affected regions
• Extremely slow regeneration of the affected bones, tissues and blood vessels

The next few sections will discuss the different types of arm fracture.

Humerus fracture

As the name indicates, the Humerus fracture is defined as the fracture of the bone of the upper arm known as the humerus. The most general symptoms of humerus fracture are- swelling, bruising and discoloration of the affected region. In a number of cases, the neurovascular bundles of the arm are badly affected. This may lead to the loss of nerve function and disrupted circulation to the site of injury. Humerus fractures are caused by vehicular accidents, gunshots, electric shocks, and seizures. Fractures in the humerus shaft may also be caused by metastatic breast cancers.

What are the different types of humerus fracture?

Humerus fractures are classified according to the location and type of fractures. Based on location, these are of three types-

• Proximal location: Here, the site of injury is the top portion of the humerus, close to the shoulder. It may be of four types namely- greater tubercle fracture, lesser tubercle fracture, surgical neck fracture and anatomical neck fracture.
• Middle: The bones located in the middle portion of the humerus, which is also known as the shaft of the humerus are affected in this case.
• Distal location: It indicates an injury of the base of the humerus, close to the elbow. It may restrict the flexing capacity of the elbow and may eventually lead to deformity. It has two subtypes-
• Supracondylar fracture: It is a fracture of the distal humerus, just above the epicondyles.
• Intercondylar fracture: It is a T or Y-shaped fracture that bifurcates the condyles.

Another classification of arm fracture is given below-

• One-part fracture: Here, none of the parts of the humerus are displaced.
• Two-part fracture: Here, one part is displaced with respect to the other three.
• Three-part fracture: Two displaced fragments are detected in this case.
• Four-part fracture: Here all the four fragments are dislocated.

Forearm fracture

Forearm fracture refers to the fracture caused in the portion of the upper limb, between the wrist and the elbow. It is classified into two types-

• Ulnar fracture: It is the fracture detected in one of the two long bones in the forearm. It is of two types-
• Monteggia fracture: It is a fracture of the proximal third of the ulna, accompanied by the dislocation of the head of the radius. It is of four types- Extension type, Flexion type, Lateral type and Combined type.
• Hume fracture: It is a type of elbow injury, characterized by a fracture of the olecranon and an associated anterior dislocation of the radial head.
• Radial fracture: It is a fracture of the other long bone of the forearm, which extends from the lateral side of the elbow to the thumb side of the wrist. It has the following subtypes-
• Essex-Lopresti fracture: It is a fracture of the radial head, with a simultaneous dislocation of the distal radio-ulnar joint and damage to the interosseous membrane.
• Distal radius fracture: It is also called a wrist fracture and is of the following types-
• Galeazzi fracture
• Colles’ fracture
• Smith’s fracture
• Barton’s fracture

Diagnosis

The following diagnostic processes are normally recommended-

• Radiographic imaging (X-Ray)
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)

Treatment and care

Treatment of fractured arms depends mainly on the type of fracture and its severity. Some of the treatment modalities are:

• Reduction or the setting of the bone- In case of a displaced fracture, the broken pieces are positioned back into their original place.
• Immobilization– This involves restricting the movement of a broken bone. This can be done by using a splint, sling, cast or brace. Immobilization promotes healing of the fractured bones.
• Medications– Over-the-counter pain reliever drugs such as certain Nonsteroidal anti-inflammatory drugs (NSAIDs) can help if taken according to the prescribed dosage.
• Surgical intervention– Surgeries might be required in some cases to reduce the fracture. Wires, nails, plates or screws can be used for the same.
• Therapy- Physical therapy is advised to prevent the stiffness of joints and improve the functioning.

Prevention of arm fractures can be done by:

• Healthy diet– A diet rich in calcium and vitamin D is advised. Some of the recommended foods are yogurt, milk, cheese, fatty fish (such as salmon), orange juice etc.
• Exposure to the sun rays in the early hours of the day can also augment the vitamin D synthesis in the body.
• Use protective gear and preventing falls- Protective gear such as wrist guards should be worn during activities involving high-risk (such as rugby, snowboarding etc.). Making the home safer and using comfortable and sensible shoes can help in preventing falls.
• Quit smoking– Smoking has a detrimental effect on the bone mass. Thus, it can make you susceptible to bone fracture. It also interferes with the healing process.

References