Floating Elbow: Symptoms & Treatment

Floating elbow is a medical term that was first introduced by Stanitski and Micheli to describe an injury in children that involves concomitant fractures of the forearm axis and supracondylar humerus in the same extremity. This medical term has also been extended to include adult patients who suffers from ipsilateral fractures of the humerus and forearm. Floating elbow is usually associated with an elbow dislocated in patients suffering from high impact injuries following a serious incident such as a car crash. The “floating” term is used when the elbow remains dislocated from the hand and shoulder.

The most likely cause of such injury for children is due to a fall on the outstretched arm with the forearm pronated and wrist hyperextended. Direct trauma can also result in this injury. Adult patients suffer from floating elbow largely due to high speed trauma such as an accident or falls from extreme heights.

The most obvious symptom in patients with floating elbow is tremendous pain and an obvious deformity in the affected elbow. There is also a possibility of injuries to the surrounding soft tissues such as the ligaments and tendons and this will depend on the mechanism of injury and severity of pathology.

The severity of injury varies among patients depending on several factors such as the position of the arm and impact of force. The nature of treatment is likewise affected by such factors. Management of floating elbow differs slightly between children and adults. However, the initial management is ultimately provisional immobilisation of the fracture. The injured extremity will be protected by a cast and supported by an arm sling.

Surgical options include either a rigid plate fixation or locked intramedullary nailing of the fracture. Both options will provide stability and a high chance of union. Rigid plate fixation will decrease the downtime and will promote early regaining of the full range of motion in the affected joint. In children however, a closed reduction surgical technique is preferred as it provides the highest chances of union with the least possibility of deformity. A mixture of surgical options is accompanied by post-surgery complications. In rare cases, neurovascular injuries may be initiated by a floating elbow injury although chances are slim. These neurovascular injuries can be in the form of nerve palsy to branchial plexus lesions. Infection following surgery is also a possible factor especially for patients who have open fractures and immediate internal fixation.

 

 

Coronoid Fracture: Cause & Symptoms

Coronoid fractures often happen in the ulna although they are relatively uncommon. However, coronoid fractures can be critical injuries. They usually occur in conjunction with elbow dislocations and will lead to elbow instability. The coronoid is designed to strengthen the elbow, increasing the stability. Therefore, a fracture will lead to unstable elbows and a possible loss of motion.

Traumatic elbow injuries such as a coronoid fracture will usually result in a dislocation of not only the bony structures but also injuries to the soft tissues. Very often, the posterior elbow is dislocated and managing it is extremely difficult. Unlike other fractures, coronoid fractures do not respond well to close reduction or splinting.

Causes

Coronoid fracture usually comes hand in hand with an elbow dislocation as dislocation itself involves a large energy impact onto the surrounding bones and soft tissues, leading to several severe soft tissue injuries. This usually happens during high impact sports such as rugby or accidents. One of the most common cause is a fall from a certain height, landing on an outstretched arm when trying to break the fall. The main mechanism involves a combination of twisting and flexing. When the elbow is loaded axially, it is in its weakest state and will lead to the weakening of the coronoid.

Symptoms

Patients suffering from coronoid fractures often have the following symptoms. Patients will be in tremendous pain with diffuse swelling and tenderness. The level of tenderness can be multifocal and depends of the area of injury. Range of motion including flexing, extension and rotation will be severely limited or totally impossible.

Complications

Coronoid fractures may lead to complications if it is not treated properly. The ends of broken bones are sharp and they can cut and tear surrounding blood vessels, nerves and tendons. Fractures may also lead to excessive bleeding and swelling in the elbow region, causing blood clot formation and the disruption of normal blood flow to the rest of the arm. This will lead to a loss of sensation and even function of the arm, requiring emergency attention.

Management

Patients suffering from coronoid fractures will have unstable elbows and it can be fixed by suturing the bone and anterior capsule to the anterior ulna. Surgery will involve either internal fixation or replacement of the fractured radial heads. The injured ligaments need to be surgically reconstructed and if the elbow is still unstable, hinged external fixation will be required.

Femur Shaft Fractures (Broken Thighbone): Cause & Treatments

Our femur is the strongest and longest bone in our body. Due to the high strength, an extremely large force is necessary to cause any fracture. These situations can include a high speed car crash and this is the most common reason for such fracture. A force that is beyond the normal limits of the femur will result in a fracture. The long and straight part of the femur is called the femoral shaft and when there is a break along the femoral shaft fracture, it is known as a femoral shaft fracture.

Causes of a femoral shaft fracture

Femoral shaft fractures usually occur in young people due to the type of activities they engage in. Most youngsters engage in high impact activities such as wakeboarding, football and racing. The most common reason is an automobile accident resulting in a car crash. Other less common causes can be an accidental fall from a certain height or even a simple fall in people of a higher age group. This is due to their weakened bones or existing medical conditions such as osteoporosis.

Treatment

Non-surgical treatment

Non-surgical treatment is meant for patients who do not have a displaced femoral shaft fracture. In cases like this, treatment will involve the usage of walking aids such as crutches or walker with the foot in a protective brace or splint for a period of time. However, most femoral shaft fractures will require surgery to properly heal.

Surgical treatment

Surgical treatment is needed for those who have displaced femoral shaft fractures and this will usually involve the realignment of the bones. Metal pins and screws will be placed into the bones located above and below the fracture site to properly hold the bone in the proper position to facilitate healing. It is a temporary treatment and will provide adequate stability until the patient is ready for stage 2 of the surgery – intramedullary nailing. A metal rod will be inserted into the marrow canal of the femur to hold it in its proper position. It is then screwed to the bone at both ends. The bone fragments will also be cleaned and joined together with the femur using screws and metal plates.

Patients suffering from a femur fracture should seek prompt medical attention as ignoring such symptoms will cause more damages to the femur and prevent healing of the fracture altogether, leading to a lifetime of instability and pain.

 

Bennett Fracture: Cause & Treatments

A Bennett fracture happens when the bone located at the base of the thumb dislocates and breaks. It can be due to a sudden trauma during high impact sports or accidents. A Bennett fracture will result in swelling of the thumb, pain and the inability to use the thumb. In this article, we will look at the causes and treatments for Bennett fractures.

Causes

The causes of a Bennett’s fracture can differ. However, it happens when the metacarpal bone located in the arm fractures and breaks. This can be due to any kind of forces that will result in a huge impact sufficient to break it.

Treatments

Treatment is classified into non-surgical and surgical. For minor cases where the bones are not misaligned, non-surgical will be more than sufficient. The initial stages of treatment will involve the famous RICE therapy – Rest, Ice, Compression and Elevation. Resting involves immobilising the injured hand and preventing any stresses on it. During this period, the patient is not allowed to participate in any activities. Several times a day, the injured thumb will need to be iced in order to bring down the swelling. To prevent swelling and loss of blood, compression finger sleeves may be worn. This will also help to retain body heat and enhance blood circulation. Lastly, the injured thumb needs to be elevated above the heart to drain away excess blood. Bracing and casting may be required depending on the activity level of individual patients.

Surgical treatment is also classified into invasive and minimally invasive. In minimally invasive surgery, a surgical wire will be inserted through a small incision aided by cameras. However, this method is highly dependent on the stability of the injury and the alignment of the metacarpal bone. If the bones fragments are scattered, an invasive surgery will need to be carried out in order to remove these bone fragments. A small screw will be used to hold the fragments together until they heal on their own. One popular surgical treatment is the Kirschner wire fixation. The K-wires are made up of surgical grade stainless steel and are temporary fixation tools. The pins are drilled into the bones and act as an anchor point for skeletal traction.

Unlike other injuries, Bennett’s fracture cannot really be prevented due to the various uses of the hand and the fingers. However, this fracture can be avoided to a certain extent using medical tapes to tape the thumb and index finger together.

 

 

 

Adult Forearm Fractures: Cause & Treatments

Our forearm is connected by two bones, the radius and ulna. In an event of a forearm fracture, both of the bones are often broken. The location of the fracture can be in several areas. It can appear at the wrist area, middle of forearm or nearer to the elbow. The main function of the forearm is to facilitate rotation of the wrist. This rotation movement allows us to turn our palms upwards or downwards. A forearm fracture will severely limit the amount of work we can do.

Causes

Fractures are usually caused by a sudden stress acting on it that is beyond the usual limit. In the case of forearm fractures, there are 3 main situations that can cause such an injury – a sudden blow to the forearm, a sudden compression to the forearm or over rotation of the forearm. The ulna is the bone that is often broken by the above scenarios. Twisting fractures can also occur due to high impact sports or fall from heights landing on an outstretched arm. There will also be damages and injuries to the soft tissues such as the muscles and tendons.

Treatment

Non-surgical

The first step would be a first aid evaluation by a medical professional. The fractured arm will be immobilized using a splint or sling. An isolated fracture can be easily treated using this method and it will heal on its own. Realignment surgery is not necessary if there are no mis-aligned bones or protruding bones.

Surgical – Internal fixation

In serious cases, surgery will be required in order to promote healing and recovery. A fixation surgery will be carried out to realign and fix the fracture bones together. The bones will be connected using metal plates and screws and this will allow early recovery of movement, reducing the chances of bone resorption. A cast is required after surgery as well to add weight to the bone.

Surgical – External fixation

In cases where there is the presence of open wounds or damages to the skin, internal fixation is not recommended due to the chances of further injuries. Thus, external fixation is preferred. As the name suggests, external fixation involves fixing screws on the outside of the body. Screws will be attached around the fracture site using a metal bar. This metal bar acts as a stabilizing frame to hold the bone in proper position until it heals on its own.

Olecranon Fractures: Treatment & Management

Our elbow is a complex hinge joint made up of three different bones. It can also perform various functions. The elbow is able to bend and straighten up, rotate and turning up and down. When you try to bend your elbow, the sharp tip protruding out is called the olecranon. Olecranon fractures are injuries that affect the particular bone.

Treatment

After a patient suffers from an Olecranon fracture, the first thing a doctor will administer is ice and pain relief medication followed by elbow immobilization. The doctor will then determine if surgery is required depending on the extent of the fracture.

Nonsurgical treatment

Patients who do not have a severe fracture will not be required to undergo surgery. Nonsurgical treatment is fairly straightforward. The patient will need to immobilize the fractured elbow using a splint or sling during the healing process. The patient will also need to visit the hospital once a week for X-ray imaging to monitor the healing process. If there are no protruding bone fragments, movement will resume after a month. During the healing process, a physiotherapist will be assigned to teach basic strengthening exercises. If the fracture shifts during this process, the patient will eventually surgery to piece the bones together.

Surgical treatment

Surgery will be needed for patients who have serious fractures such as an open fracture or displaced fracture. In a displaced fracture, the fracture is out of place. This is due to the strong attachment of the bicep muscles to the olecranon. Once the fracture is out of place, the elbow will be unable to straighten at all. An open fracture on the other hand means that the bone fragments have cut the skin, leading to an increased risk of infection. This is a much more serious condition and patients will be administered with antibiotics and tetanus shot. An incision will be made at the back of the elbow where the surgeon will piece the bone fragments together again. Large pieces of bones may be joined together using pins, wires, screws or plates and these metal implants can be permanent or biodegradable.

Management

Following surgery, rehabilitation will be required in order to regain the elbow to its previous condition. As the healing process is lengthy, bone resorption could have taken place. As such, the region is much weaker. A physiotherapist will thus concentrate on regaining bone mass and muscular strength in the elbow.

Causes and Symptoms of Ankle Fractures in Children

Ankle fractures are common injuries in Children. This is largely attributed to the lack of fully developed strong bones in them and the increased intensity of activities in their daily lifestyle. Ankle fractures occur when there is a break in one of the ankle bones namely the tibia, fibula or talus. Ankle fractures in children usually involve either both the tibia and fibula instead of the talus due to the involvement of growth plates responsible for the regulation of bone growth. Immediate medical attention should be sought as delayed treatment will have a long term irreversible impact on the growth and shape of the adult bone.

Causes

Twisting

Children usually fracture their ankles during intense activities such as basketball, soccer or volleyball. Twisting occurs unexpectedly and no one can predict the exact action that will occur. Twisting can happen while jumping and landing awkwardly or a sudden direction change.

Growth plates

The outside long bones do not growth from the centre. It actually grows from the ends of the bones and when a child becomes an adult, these growth plates will harden up into a bone on its own. Since growth plates are the last few bones in the body to fully form, they are weaker in mechanical strength and are at a higher risk of fracture. As a result, twisting that occurs from the scenarios mentioned above will usually lead to growth plate fractures.

Missing a step

Fractures resulting from missing a step on the stairs are common injuries especially in children due to their lack of ability to react instantly. The sudden jerking action will lead to a resultant twist which will cause a broken bone to happen.

Symptoms

Bruising and swelling

Bruising and swelling are the most common and almost immediate symptom of an ankle fracture. This is due to the body’s defense system rushing all the blood to the affected area to fight any infections, leading to an increase in fluid amount.

Pain

The ankle will be extremely painful and tender to touch. Bearing weight on the injured ankle will be an almost impossible task and slight movements will result in a sharp pain.

Bone fragments poking out

The most obvious symptom would be the sight of a bone fragment pushing against the skin. This is extremely dangerous and immediate medical attention is required in order to push back the bone to its proper place through surgery.

Ankle fractures in children are common injuries in children and can lead to serious long term complications on the bone development in them. Medical attention should be sought and self medication should not be attempted.

Hairline Fractures and Their Causes

Hairline fractures, otherwise known as stress fractures are caused by repetitive forces acting on the bones usually in places such as the foot and lower limb. Due to an imbalance between the resorption and growth of new bone tissues and cells, bones are unable to regenerate and timely replacement cannot happen. Due to this fatigue, micro cracks in the form of hairline fractures are ultimately formed. What are some causes of hairline fractures?

High impact sports

High impact sports such as soccer, basketball and rugby are at a higher risk of developing stress fractures. This is due to the stressful nature of the game and the forces involved. The 3 sports require constant jumping and running throughout the duration of the game. Over time, fatigue will kick in due to insufficient rest and micro cracks will happen as a result.

Increase in intensity of activities

Fractures can happen to people who have a sudden change in the intensity of their activities. For someone who is used to sitting in the office for prolonged periods of time, a change in lifestyle can lead to a rapid increase in intensity of activities and cause hairline fractures. This is especially so in people who are trying to lose weight or increase muscle mass. A sudden increase in physical activities will place tremendous pressure on the body and lead to a higher risk of injury.

Menopause

Menopause in women will result in the thinning of bones and studies have concluded that an average woman loses 10% of her bone mass within the first 5 years. Menopause will cause a drop in oestrogen levels which is responsible for maintaining bone strength in women. Due to this decrease in bone mass, it is at a higher risk of fractures, especially stress fractures.

Ballet dancers

Ballet dancers are often required to be using the ball of their foot and this adds a lot of stress to the bones there as the entire body weight is acting on this. Coupled with requirements to turn and jump around, the intensity is amplified, placing the foot to be at an extremely high risk of hairline fractures.

Causes of hairline fractures are plenty and they are quite painful. However, due to their tiny nature, they often heal themselves within a few months if proper care is administered. They can be caused by daily routines as well as sports. Be mindful of restraining yourself from strenuous activities when you are a patient of hairline fractures and you will soon be on your way to pre-injury status.

Taking Care of Sports Injuries: Leg Fractures

Beneath our skin is the human skeletal system comprising of 206 bones working in tandem with soft tissues such as ligaments, tendons and cartilage to perform critical bodily functions such as movements and regulations. Making up the skeleton are bones and these bones can be fractured when a large enough external force is acted against it. Leg fractures are the condition whereby either the femur, fibula or tibia bones in the leg are broken. There are many possible causes for leg fractures and the main culprit is often overuse injury.  In this article, we will be discussing about how best to care for sports injuries such as leg fractures.

Splint

Splint is often the first treatment administered to patients with leg fractures. Many people mistaken splint as casts and it is important to be able to differentiate. Splints do not surround the entire fractured bone and is often only padded on one or two sides to provide protection and support. Splint helps to restrict unwanted movements which could further aggravate the fracture and due to its “open” nature, it allows swelling to happen. Doctors will usually apply a splint to the patient for a few days until the swelling has subsided and will then follow on with a immobilisation cast.

Casts

After the swelling has subsided, a cast can then be used. Casts are large, hard bandages made of plaster or lightweight fibreglass which completely immobilise the bone to accelerate healing. The internal padding is made up of comfortable cotton lining which helps to absorb perspiration.

Elevating the leg

Whenever possible, the patient should always try to elevate the injured leg to a position above the heart. This helps to reduce swelling and drain the fluids down and away. Elevating the leg also reduces pain and accelerates the healing process.

Keeping away from water

Utmost care should be taken to keep away from water during this period if it is made of plaster. Water will disintegrate the plaster and render it useless. The water can also react with the plaster and cause rashes to form on the skin.

Using walking aids

Before the bone has completely healed, you should not bear weight on it to prevent further injuries and hinder the recovery process. When you are moving around, you should always use a walking aid such as a crutch to assist you.

Leg fractures are troublesome injuries that have a significant impact on your daily life. However, with the proper care and treatment, recovery time should not take too long and you will not be far off the track.

4 Symptoms of a Hairline Fracture

Hairline fractures or stress fractures are not easily detected or felt as compared to other types of fractures. Patients may sometimes feel tenderness at the affected area coupled with some swelling. These symptoms are further amplified during activities and will reduce with rest. Hairline fractures are actually tiny cracks in a bone resulting from overuse and are frequently observed in places where repetitive loads are encountered such as the ankle. Hairline fractures often occur during high impact sports and a few factors can influence it such as the duration of exercise, frequency of exercise as well as the intensity of it. However, patients who do not participate in sports can also experience hairline fractures due to weak bones in their body. Bone diseases or osteoporosis causes a loss in bone density and places one to be more susceptible to stress fractures. In this article, we will further explore some symptoms of a hairline fracture.

Gradual pain

Pain develops gradually in patients suffering from stress fractures. As mentioned above, the pain is only present during instances of weight bearing and will go away at rest. It is different from an ankle sprain whereby pain is present throughout. In some patients with higher pain tolerances, they may not be able to feel this pain as the endorphins produced during activities can mask it, misleading the patients and result in more serious consequences.

Localised swelling

During injuries, our body’s immune system will kick in. Chemical signals are released by the brain to widen capillaries which will result in increased blood flow to the injured area. The white blood cells will then fight against any infection present. This increase in fluid causes swelling which is visible on the outside and can be relieved through the use of ice packs or anti-inflammatory medication.

Reduced pain when at rest

Another common symptom is the immediate reduction of pain experienced when at rest. This would mean that the injury sustained is not involving any muscle groups nor is it a major fracture. Patients suffering from hairline fractures will get immediate relief when they stop whatever activities they are doing.

Constant pain after continuous trauma

When patients ignore the advices of doctors to rest and choose to continue playing, their condition can worsen and there is a high risk that the stress fracture has already evolved into a complete fracture. Pain can be felt throughout even when the patient is at rest.

It only takes about 6 to 8 weeks for a hairline fracture to heal whereas a complete fracture takes around 6 months to heal. It is up to you whether you wish to sacrifice at most 2 months of your time to heal it completely or risk being out of the sport forever.