Diagnosis
The method of choice for diagnosing a forearm fracture is X-ray. Here, X-rays are directed for a short period of time at the suspected site, whereby the denser bone is brightly imaged in front of the hydrated muscle and fatty tissue. Fractures are relatively easy to recognize on X-rays, the procedure is inexpensive and does not take long.
A lead apron is worn to protect the rest of the body from X-rays. The radiation exposure is in the range of 0.5 millisievert. For comparison: the total radiation exposure per person in Germany in 2005 was around 2.5 millisieverts.
However, an X-ray does not necessarily have to be taken: A clinical examination taking into account the fracture signs mentioned above can also provide an indication of a fracture. At this point, here are a few more tips on the acute treatment of a fracture: First and foremost, it is important to stop any bleeding, since up to half a liter of blood can be lost via the forearm. In an emergency, this is usually done by tying the upper arm tightly.
Care must be taken to ensure that the blood supply is not cut off to the extent that tissue dies. Furthermore, it is best to follow the easily remembered PECH scheme: 1. rest (immobilization) 2. ice (cooling the arm to prevent swelling) 3. compression (applying a pressure bandage) 4. elevation (to reduce the blood flow from the wound) Furthermore, a repositioning should definitely be carried out by a physician, since improper treatment can cause vessels and nerves to become trapped. In extreme cases, this can lead to the death of the arm.
The first point of contact after emergency treatment is therefore the hospital outpatient clinic, or the doctor you trust! The therapy can be conservative or surgical. Although there are certain guidelines, the final method of treatment is mainly at the discretion of the attending physician – and of course the treated patient.
As a rule of thumb, simple and uncomplicated fractures can easily be treated conservatively, i.e. with plaster, while comminuted fractures and complicated fractures must be treated surgically using the osetosynthesis method. In conservative therapy, the arm is clamped in a so-called “finger trap”: The fingers are fixed overhead in the finger trap and weights are attached to the angled upper arm. After a good 10 minutes, the tissue is stretched so far that the two broken bone ends no longer lie on top of each other.
On the other hand, after this time, the patient is no longer expected to counter-tension involuntarily, so that the fracture can be reduced more easily. Once this has been done, a plaster cast is applied as described above. The plaster must also be worn for 6 weeks.
Surgery is usually attempted for complicated multiple fractures, elderly patients and polytraumas. For osteosynthesis, screws or plates made of titanium are used, which are screwed into the bone in such a way that the fragments are rejoined and stabilized. The materials used also depend on the type of fracture: While the two bones can be “simply” screwed together in the case of a longitudinal fracture, a titanium plate that fixes the ends of the bones together is recommended for a smooth fracture.
For this purpose, so-called “Kirschner wires” are often used, with which the two bones are pulled together intramedullary – i.e. lying in the medulla. Kirschner wires are also suitable for fixing smaller, detached bone pieces to the bone. However, surgery can usually be performed under local anesthesia.
Especially in the case of forearm fractures, the nerve fibers of the forearm are anesthetized using a local anesthetic, the so-called brachial plexus anesthesia.This relatively complication-free procedure is also called “Axilliary Blockage”, because the brachial plexus supplying the arm is located in the armpit area. Depending on the severity of the fracture, an operation takes at least half an hour. Special attention is paid to the blood and nerve supply to the forearm. Pinched arteries or nerves can cause complications such as loss of sensitivity, restricted movement or even death of the arm during the healing process. However, various clinical tests and X-ray control ensure that such complications are rather the exception than the rule.
