ELBOW FRACTURE, CORONOID PROCESS |
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General Information
DEFINITION--A complete or incomplete break in the coronoid process of the ulna (a part of a bone in the forearm). It usually accompanies an elbow dislocation.
BODY PARTS INVOLVED
Elbow joint.
Coronoid process of the ulna, a curved portion of the bone that forms part of the joint.
Soft tissue surrounding the fracture site, including nerves, tendons, ligaments, blood vessels, cartilage and muscle.
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SIGNS & SYMPTOMS
Severe pain at the fracture site.
Swelling around the fracture.
Visible deformity if the fracture is complete and bone fragments separate enough to distort normal body contours.
Tenderness to the touch.
Numbness or coldness in the lower arm and hand, if the blood supply is impaired.
CAUSES
Direct blow to the elbow.
Indirect injury due to falling on an outstretched hand with the elbow stiff, or any injury that causes dislocation of the elbow.
RISK INCREASES WITH
Activities such as gymnastics or cheerleading.
History of bone or joint disease, especially osteoporosis.
Children under 12 and adults over 60.
Obesity.
If surgery is necessary, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Build adequate muscle strength and achieve good conditioning prior to exercise, athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
Use appropriate protective equipment, such as padded elbow pads, when participating in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment to aspirate blood from the elbow joint and to remove the coronoid process surgically or to reattach it to its normal position.
Hospitalization for surgery to set the fracture and repair soft tissues of the elbow.
Whirlpool, ultrasound or massage (to displace excess fluid from the injured joint space).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of injured areas, including joints above and below the primary injury site.
Repeat X-rays after approximately 1 week, if first X-rays were negative and pain continues.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissues. AFTER TREATMENT OR SURGERY:
Delayed union or non-union of the fracture.
Impaired blood supply to the fracture site.
Arrest of normal bone growth in children.
Infection in open fractures (skin broken over fracture site), or at the incision if surgical setting was necessary.
Shortening of the injured bones.
Unstable or arthritic joint following repeated injury.
Proneness to repeated injury.
Prolonged healing time if activity is resumed too soon.
Problems caused by casts. See Appendix 2 (Care of Casts).
PROBABLE OUTCOMEThe average time for healing of this fracture is 6 to 8 weeks in adults and 4 to 6 weeks in children. Healing is considered to be complete when there is no motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing, if possible. Don't move the injured elbow to remove clothing.
Use instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
The doctor will set the broken bones and repair soft tissue with surgery. Surgery is necessary to ensure normal rotation of the forearm after healing is complete. Manipulation should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose elasticity and become difficult to return to a normal position.
Immobilization will be necessary with rigid splints around the injured area to immobilize the joints above and below the fracture site.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use heat lamps or heating pads so heat can penetrate splints.
After splints are removed, use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day.
Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
Take whirlpool treatments, if available.
MEDICATIONYour doctor may prescribe:
General anesthesia for surgery.
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen (available without prescription) for mild pain after initial treatment.
ACTIVITY
Resume normal activities gradually after treatment. Don't drive until healing is complete.
Begin reconditioning the injured area after clearance from your doctor.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation.
REHABILITATIONBegin daily rehabilitation exercises when movement is comfortable. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of an elbow fracture.
Any of the following occur after surgery or other treatment:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Swelling above or below the splints.
Blue or gray skin color, particularly under the fingernails.
Numbness or complete loss of feeling below the fracture site.
Nausea or vomiting.
Constipation.
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