Open arm fracture

The most severe injury to the bone tissue of the upper limbs, in which fragments of broken bones have injured other structures: there is a rupture of muscle, connective tissue, skin, and the release of fragments of the injured bone - this is an open fracture of the arm.

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Epidemiology

An open fracture of the arm is the most common injury. As statistics show, most cases of this type of fracture are recorded in men. More than half of the cases of open fractures are in patients aged 21 to 50 years.

The most common injuries are those received in domestic or industrial conditions, as a result of a road traffic accident or a fall from a height.

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Causes open fracture of the arm

Upper limb fractures include injuries to the bones of the forearm, shoulder, elbow joints, radius, wrist, metacarpal bones of the hand, and phalanges of the fingers. In most cases, large tubular bones are subject to such injuries.

The most common causes of an open arm fracture are:

1. Falling on hand.
2. Consequence of a strong blow.
3. Heavy physical stress on the arm.
4. Age-related changes in the human body.
5. Disease:
   • Osteoporosis.
   • Bone cyst.
   • Hyperparathyroid osteodystrophy.
   • New bone tissue formations (benign or malignant).
   • Osteomyelitis.
   • Metastases in bone tissue.

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Pathogenesis

In case of an open fracture, the pathogenesis of the disease is caused by a violation of the integrity of the bones of one of the sections of the skeleton of the upper limbs. After a fracture, sharp fragments perforate the muscle tissue of the hand and damage the skin. Most often, bone fragments can be observed visually, without using special medical equipment. Open wounds due to a fracture can become infected with subsequent development of suppuration.

Traumatologists divide such injuries into fractures of pathological and traumatic etiology. In trauma, the bone is subjected to sudden strong point mechanical impact, while a pathological fracture is the result of changes in bone tissues, obtained as a result of pathological processes occurring in them, caused by disease or age-related changes.

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Symptoms open fracture of the arm

It is not difficult to recognize the injury, since the symptoms of an open fracture of the arm do not allow one to doubt the diagnosis:

1. Acute and sharp pain. The pain syndrome persists even when the upper limb is at rest. When moving, the pain intensifies, a shooting sensation is felt. Pain shock is also possible.
2. An uncharacteristic, unnatural position of a part of the upper limb.
3. At the site of the fracture, there may be tissue mobility that should not occur under normal conditions.
4. When palpating, you can hear a crackling sound (crepitation) characteristic of a fracture. In some cases, this sound can be heard with a phonendoscope, and sometimes without the device.
5. Very often, protruding bone fragments can be observed.
6. The damaged tissues that form the wound bleed heavily.
7. A feeling of coldness in the injured arm may appear. This indicates a violation of hemodynamics, which occurred due to scarification of a large main artery or their blockage by a thrombus. More often, such a clinical picture is observed in elderly patients.
8. The site of injury begins to swell “before our eyes.”
9. Hematomas. Pulsation is possible at the site of their formation. This fact indicates the presence of subcutaneous hemorrhage.
10. If the nerve endings are damaged, paralysis of the upper limb occurs.
11. Decreased tactile sensitivity.

First signs

When an open fracture of the arm occurs, the first signs that the victim feels are sharp pain radiating to the shoulder area. Traumatic shock is possible. Subsequently, a bleeding wound with bone fragments coming out is visible on the arm.

Despite the small size of the phalanges, an open fracture of a finger is a serious pathology. Medical statistics "say" about 5% of such diagnoses from all cases of fractures.

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Complications and consequences

Even in the case of timely and qualified provision of first medical aid, the patient may experience consequences and complications after treatment of an open fracture of the arm:

1. Development of osteomyelitis.
2. Abnormal fusion of bone tissue, bone deformation.
3. Partial or complete loss of functionality of the affected arm.
4. In the future, both the site of the injury itself and the nearby muscle tissues and joints may hurt.
5. Fat embolism – demulsified particles of free fat enter the bloodstream.
6. If the bone does not heal properly, surgery may be required.
7. Infection of an open wound with subsequent suppuration.
8. There is a high probability of developing muscle contracture (shortening of size and decrease in muscle extensibility).
9. Limited joint mobility.
10. Circulatory disorders.
11. Muscle tissue atrophy.
12. There is a high probability of thrombosis.
13. Congestion in the lungs causing pneumonia.
14. Formation of bone callus.
15. Development of pseudoarthrosis.
16. Decreased tactile sensitivity.
17. Partial or complete paralysis of the arm.
18. Respiratory and cerebral failure are possible.

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Diagnostics open fracture of the arm

With such an injury, diagnosing an open fracture of the arm is not very difficult, since even a visual examination by a person who does not have a medical education allows one to determine the diagnosis.

X-ray examination allows to obtain the most accurate picture of the fracture, the presence of fragments, their location. Quite rarely, but it may be necessary to conduct a computed tomography.

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Treatment open fracture of the arm

When a patient is injured, treatment begins with first aid. The broken part of the arm should be properly fixed to immobilize the fracture site. This will prevent the bone fragments from shifting further when the victim is transported to the hospital.

An open fracture of the arm is accompanied by a bleeding wound. Therefore, it is necessary to stop the bleeding first.

This is done by applying a compression tourniquet.

It is essential to treat the wound with an antiseptic to prevent infection: chlorhexidine, iodine, degmicid, ethyl alcohol, decamin, hydrogen peroxide solution, ethonium, tserigel, potassium permanganate, roccal, hydroperite.

Upon arrival of the victim to the specialized trauma department, the first thing the doctor - traumatologist does is to inject a painkiller into the soft tissues of the damaged area. The following drugs are mainly used: nurofen, ketoral, bulivacaine, nimesulide, novocaine, lidocaine, naropin,

Novocaine is administered as a 0.25%, 0.5% and 2% solution by injection in a volume of 5–10 ml.

The only contraindication to the use of this drug is hypersensitivity to para-aminobenzoic acid and other components of the painkiller.

There are two further treatment options for an open arm fracture: conservative and surgical.

Conservative treatment is allowed only if the X-ray does not show numerous bone chips. The traumatologist begins to bring the bones into a natural position; if there are chipped fragments, they are returned to their place. Then a plaster cast is applied to the arm. Usually, in order to assess the quality of the joint of the elements of the broken bone, specialists prescribe a repeat X-ray. This will significantly reduce the likelihood of improper bone fusion.

If the situation is more severe, the specialist resorts to surgical intervention. The victim undergoes surgery to restore the bone under local, and in rare cases, general anesthesia.

First aid for an open fracture of the arm

In many ways, the outcome of treatment depends on the quality of timely and high-quality first aid provided to the victim with an open fracture of the arm.

The first thing to do is to disinfect the wound and stop the bleeding. This can be done using any antiseptic (for example, hydrogen peroxide or regular vodka), as well as a tight bandage that will block the injured blood vessel. If the bleeding is severe, then a compression tourniquet should be used. A rope, belt, bandage, leather belt or fabric unraveled into strips can be used as a tourniquet.

But before using a tourniquet, you should understand what type of blood loss the victim has. If the blood that flows out is dark, it is venous bleeding. The tourniquet is applied below the affected area. The tourniquet tension should be loosened every 30 minutes.

If the blood is light, scarlet, pulsating, it is dangerous arterial bleeding. With arterial bleeding, the probability of a fatal outcome is high. It should be stopped as soon as possible. In this situation, the tourniquet is applied above the affected area. It is necessary to call an ambulance. If after an hour and a half help has not yet arrived, the tourniquet pressure should be loosened for three to four minutes, and then tightened again. This is necessary to prevent tissue necrosis of the injured limb.

In order not to worsen the condition of the victim, the arm should be immobilized. It can be fixed with a splint, two wooden planks, placed on different sides of the injured limb. To prevent the splint or planks from moving, a bandage or any other available fabric is wrapped over them.

If the open fracture affects the scapula, humerus or clavicle, it is advisable to place a small cushion between the upper limb and the armpit, and tie the arm to the body.

Such an injury causes severe pain to the victim, so it is worth giving him any analgesic: analgin, spazmalgol, spazmalnin, optalgin.

The patient must be provided with a comfortable position and urgently taken to the emergency room of the traumatology department.

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Surgical treatment

In case of severe pathology, the traumatologist is forced to resort to surgical treatment of such a patient. The operation is performed under anesthesia (local or general). If the wound is infected at the time of the patient's admission to the hospital, the surgeon excises the affected tissues and sanitizes the wound cavity.

The bone is "collected" to the smallest broken pieces. For better retention in the required position, such a patient may be inserted special plates or pins made of an inert medical alloy.

If tendons and muscle tissues are damaged, the surgeon uses catgut for internal sutures to connect them differentially.

The wound is sutured and covered with a sterile bandage, and the arm is fixed with a splint.

Prevention

To reduce the risk of an open fracture of the arm, or any other fracture, you should follow a number of rules. Injury prevention includes:

1. Introducing calcium-rich foods into the diet.
2. Use of appropriate protective equipment when performing hazardous work or playing sports.
3. Minimizing situations that could trigger a fall: working at height without safety equipment, icy conditions.
4. It is necessary to monitor your health, preventing the development of osteoporosis.
5. Timely and complete cure of other diseases, the progression of which can adversely affect the condition and strength of bone tissue.
6. Approach the loads placed on your hands in a differentiated and careful manner.
7. Taking courses of medications that eliminate calcium deficiency in the body.

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Forecast

In most cases, an open fracture of the arm is treated efficiently and the prognosis for the future of such patients is favorable.

But if the patient was not given first aid promptly and correctly, this may result in disability and loss of the ability to work of the injured arm, and in rare cases even death.

The duration of healing after an open fracture of the arm depends on the condition of the victim's body (anamnesis, complexity of the fracture and presence of complications) and his age. In children and young people, due to the high level of tissue regeneration, this process occurs much faster than in elderly people.

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