Complex Trauma of the Hand & Wrist, Elbow & Shoulder

What is a Wrist Fracture?

The wrist is comprised of two bones in the forearm, the radius and ulna, and eight tiny carpal bones in the palm. The bones meet to form multiple large and small joints. A wrist fracture refers to a break in one or more of these bones.

Types of Wrist Fractures

The types of wrist fractures include:

• Simple wrist fractures, in which the fractured pieces of bone are well aligned and stable
• Unstable fractures, in which fragments of the broken bone are misaligned and displaced
• Open (compound) wrist fractures, which are severe fractures in which the broken bones cut through the skin. This type of fracture is more prone to infection and requires immediate medical attention.

Causes of Wrist Fractures

Wrist fractures may be caused by a fall on an outstretched arm, vehicular accidents or workplace injuries. Certain sports such as football, snowboarding or soccer may also be a cause of wrist fractures. Wrist fractures are commonly associated with osteoporosis, a condition marked by the brittleness of the bones.

Signs and Symptoms of Wrist Fractures

The common symptoms of a wrist fracture include severe pain, swelling, and limited movement of the hand and wrist. Other symptoms include:

• Deformed or crooked wrist
• Bruising
• Numbness
• Stiffness

Diagnosis of Wrist Fractures

Your doctor performs a preliminary physical examination followed by imaging tests such as an X-ray of the wrist to diagnose a fracture and check the alignment of the bones. Sometimes a CT scan may be ordered to gather more details of the fracture, such as soft tissue, nerves or blood vessel injury. MRI may be performed to identify tiny fractures and ligament injuries.

Your doctor will order a bone scan to identify stress fractures due to repeated trauma. The radioactive substance injected into the blood gets collected in areas where the bone is healing and is detected with a scanner.

Treatment for Wrist Fracture

Your doctor may prescribe analgesics and anti-inflammatory medications to relieve pain and inflammation caused by a wrist fracture.

Fractures that are not displaced are treated with either a splint or cast to hold the wrist in place.

If the wrist bones are displaced, your surgeon may perform fracture reduction to align the bones. This is performed under local anesthesia. A splint or a cast is then placed to support the wrist and allow healing.

Surgery is recommended to treat severely displaced wrist fractures and is carried out under the effect of general anesthesia. Some of the common surgeries may include:

• External fixation, such as pins may be used to treat the fracture from the outside. These pins are fixed above and below the fracture site and are held in place by an external frame outside the wrist.
• Internal fixation may be recommended to maintain the bones in proper position while they heal. Devices such as rods, plates and screws may be implanted at the fracture site.
• Bone grafts may be used to treat crushed or missing bone. These are taken from another part of your body, bone bank or using a bone graft substitute.

Rehabilitation for Wrist Fracture Surgery

During the healing period, you may be asked to perform some motion exercises to keep your wrist flexible. Your doctor may recommend hand rehabilitation therapy or physical therapy to improve function, strength and reduce stiffness.

Risks and Complications of Wrist Fracture Surgery

As with any procedure, wrist fracture surgery may involve certain risks and complications such as:

• Infection
• Residual joint stiffness
• Arthritis

What is Elbow Dislocation?

The arm in the human body is made up of three bones that join to form a hinge joint called the elbow. The upper arm bone or humerus connects from the shoulder to the elbow to form the top of the hinge joint. The lower arm or forearm consists of two bones, the radius, and the ulna. These bones connect the wrist to the elbow forming the bottom portion of the hinge joint.

The bones are held together by ligaments to provide stability to the joint. Muscles and tendons move the bones around each other and help in performing various activities. Elbow dislocation occurs when the bones that make up the joint are forced out of alignment.

Causes of Elbow Dislocation

Elbow dislocations usually occur when you fall onto an outstretched hand. It can also occur from a traumatic injury such as a motor vehicle accident.

Symptoms of Elbow Dislocation

When the elbow is dislocated you may experience severe pain, swelling and lack the ability to bend your arm. Sometimes, you cannot feel your hand or may have no pulse in your wrist because arteries and nerves that run along your elbow may be injured.

Diagnosis of Elbow Dislocation

To diagnose elbow dislocation, your doctor will examine your arm. Your doctor will check the pulses at the wrist and evaluate the circulation to the arm. An X-ray is necessary to determine if there is a break in the bone. An arteriogram, an X-ray of your artery, can be helpful to determine if the artery is injured.

Treatment Options for Elbow Dislocation

An elbow dislocation is a serious injury and requires immediate medical attention.

Things You can do at Home when you have an Elbow Dislocation

At home, you may apply an ice pack to the elbow to ease pain and swelling. You can also check if the arteries and nerves are injured. You can feel your pulse by pressing the tips of your fingers at the base of your wrist. They should turn white or blanch and a pink color should come back in 3 seconds. To check for nerve injury, first, bend your wrist up and move your fingers apart and then touch your thumb to your little finger. You can also check for numbness all over your hand and arm. If you have a problem with any of these tests you need to see your doctor right away.

What your Doctor Does to Treat an Elbow Dislocation

Your doctor will put your dislocated elbow back in place by pulling down your wrist and levering your elbow. This procedure is known as a reduction. As it is a painful procedure you may be given medications to relieve your pain before the procedure. After the reduction, you may have to wear a splint to immobilize your arm at the elbow. After a few days, you may also need to perform gentle motion exercises to improve the range of motion and strength.

Shoulder Anatomy

The shoulder is the most flexible joint in the body, enabling a wide range of movements. It is a ball-and-socket joint made up of three bones, namely the humerus (upper arm bone), scapula (shoulder blade) and clavicle. The head of the humerus articulates with the socket of the scapula called the glenoid cavity. The clavicle bone or collarbone is an S-shaped bone that connects the scapula to the sternum or breastbone. It forms two joints: the acromioclavicular joint, where it articulates with the acromion process of the scapula, and the sternoclavicular joint, where it articulates with the sternum or breastbone. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

What is a Shoulder Fracture?

A break in a bone that makes up the shoulder joint is called a shoulder fracture.

Types of Fractures

The clavicle and end of the humerus closest to the shoulder are the bones that usually get fractured. The scapula, on the other hand, is not easily fractured because of its protective cover by the surrounding muscles and chest tissue.

Causes of Shoulder Fracture

Clavicle and humerus fractures can occur by a direct hit from a motor vehicle accident, collision or fall. A fracture of the scapula can occur by high-energy trauma during an accident from a high-speed motor vehicle.

Signs and Symptoms of Shoulder Fracture

The common signs and symptoms of a shoulder fracture may include:

• Pain
• Swelling
• Bruising
• Difficulty in lifting your arm
• Numbness, tingling or coldness of the hand and forearm
• The popping sound also referred to as crepitus, heard or felt at the time of the fracture

Diagnosis of Shoulder Fracture

A shoulder fracture is usually diagnosed based on a thorough physical examination, and imaging studies such as X-rays and CT scans.

Treatments for Shoulder Fractures

The treatment for a shoulder fracture is based on the type of fracture. Treatment can include non-surgical and surgical methods.

A broken clavicle bone usually heals without surgery. Non-surgical treatments for shoulder fractures may include immobilization by placing your arm in a sling, pain medication and physical therapy. If the fracture has led to the displacement of the bones, then surgery may be required to correct and fix them with pins, plates or screws.

Post-surgery, physical therapy may be recommended to aid in the recovery and improve range-of-motion and strength of the arm.

Anatomy of the Shoulder

The shoulder joint is a ball and socket joint. A ball at the top of the upper arm bone (humerus) fits neatly into a socket, called the glenoid, which is part of the shoulder blade (scapula). The glenoid is surrounded by a ring of fibrous cartilage called the labrum for stabilization of the shoulder joint.

What is Shoulder Dislocation?

Sports that involve overhead movements and repeated use of the shoulder at your workplace may lead to sliding of the upper arm bone from the glenoid. The dislocation might be a partial dislocation (subluxation) or a complete dislocation causing pain and shoulder joint instability. The shoulder joint often dislocates in the forward direction (anterior instability), and sometimes in the backward or downward direction.

Symptoms of Shoulder Dislocation

The most common symptoms of shoulder dislocation include pain and shoulder joint instability. Other symptoms such as swelling, numbness and bruising may also occur. At times, it may cause tears in the ligaments or tendons of the shoulder and nerve damage.

Diagnosis of Shoulder Dislocation

Your doctor will examine your shoulder and may order an X-ray to confirm the diagnosis.

Treatments for Shoulder Dislocation

The condition is treated by a process called closed reduction, which involves placing the ball of the upper arm back into the socket. Following this, the shoulder will be immobilized using a sling for several weeks. Ice may be applied over the area 3-4 times a day. Rehabilitation exercises may be started to restore range of motion, once the pain and swelling decrease.