Fractures of the wrist/elbow/patella/humerus

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Fractures (breaks) can occur anywhere in the body including the wrist, elbow, patella and humerus. Some fractures are more serious than others, but all require time and treatment to heal properly.

Understanding fractures
Fractures are breaks in the bones that typically occur as a result of force but not all fractures are the same. Some fracture types include:

  • Stable – this type of fracture features a clean break line. The ends of the bone are aligned and close together
  • Compound – a bone fracture where the skin over the fracture site opens as a result of the injury itself or when the broken bone punctures the skin
  • Closed or simple – a fracture with the skin intact
  • Transverse – a fracture line that runs horizontally
  • Spiral – a break that spirals around the bone due to a twisting injury
  • Oblique – a fracture that runs in a diagonal fashion across the bone
  • Comminuted – a shattered bone broken into three or more pieces usually due to a crushing injury

Specific fractures
Depending on the particular bone that is affected, special care may be required.

  • Humeral fractures – breaks that occur in the humerus (the upper arm bone that runs between the shoulder and the elbow) are not common, but they do occur. When the humerus does break, it is often due to a fall or direct blow and is more common in individuals with osteoporosis, a condition that causes the bones to become porous and weak. Distal humerus breaks are those that occur near the elbow and are rare. Proximal humeral fractures occur near the shoulder joint and may affect the shoulder joint itself. Humeral fractures that are located at the midway point of the bone are called diaphyseal humeral fractures
  • Wrist fractures – the radius bone is the larger of the two bones in the lower arm, the distal end of the radius is the portion of the bone near the wrist. Radius fractures occur more often than any other type of arm fracture. These breaks usually occur as a result of a fall on an outstretched arm. Most wrist fractures are located approximately one-inch from the end of the bone. When the broken fragment of the radius bone tilts upwards, it is known as a Colles fracture
  • Elbow fracture – the bone that sticks out from the elbow when the arm is bent, is called the olecranon. The olecranon is part of the ulna, the smaller of the two bones found in the lower arm. Elbow fractures typically occur as a result of a fall to the elbow or a forceful direct blow to the elbow
  • Patella (kneecap) fractures – the patella is located at the front of the knee. Its role is to protect the knee joint, but its position places it at risk of fracture in a direct, high-impact blow. The fracture may be stable or displaced and some injuries cause the patella to shatter. A patellar fracture can make it difficult to straighten the leg or walk. Individuals who have sustained patellar fractures may later develop arthritis, permanent muscle weakness or chronic pain

Diagnosing fractures
X-ray is used to confirm diagnosis of a fracture but physical examination can provide valuable information as to whether or not blood flow has been impeded, signs of nerve damage are present and if skin is broken increasing the risk of infection.

Treatment of wrist/elbow/patella and humeral fractures
The goal of all fracture treatment is to stabilize the break in the correct position until healing takes place. Depending on the type and severity of fracture, this can be accomplished through the use of a splint, cast or sling that typically remains in place for a period of six to eight weeks.

Some fractures require surgical treatment. These include displaced, open (compound), transverse or comminuted fractures. Surgical repair may require bone graft or the use of pins, plates, screws, external fixators (an outside frame that helps bones maintain the correct position during healing), and other devices to align and stabilize the bone.

Rehabilitation and physical therapy is needed after healing takes place to facilitate the return of range of motion, reduce stiffness and muscle strengthening.

Orthopedic Surgeons

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