Broken Arm

 

Broken Arm Overview

A broken or fractured arm means that one or more of the bones of the arm have been cracked. This is a common injury occurring in both children and adults. In adults, fractures of the arm account for nearly half of all broken bones. In children, fractures of the forearm are second only to broken collarbones.

·                                 Basic anatomy: The arm consists of 3 major bones. The humerus runs from the shoulder to the elbow. This is called the upper arm, or, simply, the arm. At the elbow, the humerus connects with 2 bones: the radius and the ulna. These bones go from the elbow to the wrist and are regarded as the forearm.

·                                 Important terms related to a broken arm

o                                                       Alignment: The relationship of how the broken portions of the bone come together. This is an indication of how badly a bone is broken.

o                                                        Angulation: The angle formed by the broken pieces of bone. Another measure of the seriousness of the break.

o                                                        Closed fracture: A broken bone without an open skin wound

o                                                        Comminuted fracture: A bone that is broken in multiple pieces

o                                                        Dislocation: A bone that has come out of a joint

o                                                        Displaced fracture: A broken bone with the parts of the bone not aligned

o                                                        Fracture: A crack in the bone. This is another word for a broken bone.

o                                                        Fracture-dislocation: A broken bone that has also come out of a joint

o                                                        Greenstick fracture: An incomplete fracture seen in children where only one side of the bone is broken

o                                                        Malunion: Healing of the bone in an unsatisfactory position

o                                                        Nonunion: Failure of the pieces of bone to heal back together

o                                                        Occult fracture: A broken bone that does not appear initially on the x-rays

o                                                        Open fracture (compound fracture): A fracture that has a laceration in the skin overlying the break or a fracture that has a piece of bone sticking through the skin

o                                                        Pathologic fracture: A broken bone that is due to a weakness of the bone itself from some other disease

Broken Arm Symptoms

Most broken arms have these symptoms:

·                                 A large amount of pain and increased pain when moving the arm

·                                 Swelling

·                                 Maybe an obvious deformity compared to the other arm

·                                 Possible open wound either from the bone puncturing the skin or from the skin being cut during the injury

·                                 Decreased sensation or inability to move the limb, which may indicate nerve damage

When to Seek Medical Care

Call your doctor after an accident if these signs are present:

·                                 Significant pain that is not relieved by ice and home pain medications such as acetaminophen (Tylenol) or ibuprofen (Motrin)

·                                 A large amount of swelling or mild deformity of the arm compared to the opposite arm

·                                 Significant pain with use or limited use of the affected arm

·                                 Pain in one specific part of the arm when it is pressed

Your doctor may advise you to go directly to a hospital's emergency department. Under the following conditions, go directly to the hospital for emergency care:

·                                 Visible bone sticking out through the skin

·                                 Heavy bleeding from an open wound

·                                 Complete lack of movement or sensation of part of the arm

·                                 Obvious deformity that looks drastically different from the usual appearance

·                                 Loss of consciousness

·                                 Many other injuries

Exams and Tests

The initial evaluation by any physician, in the office or in the emergency department, begins with a thorough history and physical exam. By finding out the details of the accident, the doctor is able to determine what damage was done based on the mechanism of the trauma.

After taking a history, the physician will do a complete physical exam with special focus on the painful areas. The doctor is looking for signs of a fracture (such as swelling or deformity) and checking for possible nerve or blood vessel damage.

X-rays are typically the test used to assess for broken bones. At least 2 views of the arm are taken. Initially, most broken bones will have an apparent fracture or other abnormality on the x-ray. Some fractures are not always visible on the first set of x-rays. In those instances, a CT scan or MRI may be done immediately for further evaluation, or follow-up x-rays may be obtained at a later date.

Broken Arm Treatment

Self-Care at Home

·                                 The most important aspect of first aid is to stabilize the arm. Do this by using a towel as a sling. Place it under the arm and then around the neck. An alternate approach to keep the arm from moving is to position a rolled and taped newspaper along the swollen area and to tape it in place.

·                                 Apply ice to the injured area. This can help to decrease pain and swelling. Place ice in a bag and leave it on the arm for 20-30 minutes at a time. It may be helpful to place a towel around the ice bag or in between the bag and the skin to protect the skin from getting too cold. Never put ice directly on the skin.

Medical Treatment

The most important aspect of treating fractures is to determine which ones can be treated with outpatient care and which require admission to the hospital.

In most instances, the broken arm will be able to be treated in the emergency department.

·                                 Most fractures will need to have a splint or partial cast applied to stabilize the broken bones. Some breaks especially in the upper arm and shoulder may only need to be immobilized in a sling.

·                                 In addition to splinting the broken arm, the physician will prescribe medicines for pain control and ice to decrease swelling.

·                                 Typically, wounds that warrant admission to the hospital are these:

o                                                        Bones that have gone through the skin or have lacerations over the broken area

o                                                        Fractures that are associated with nerve damage

o                                                        Fractures that are associated with blood vessel damage

o                                                        Complicated fractures that have multiple breaks, involve the joints, or are unable to be stabilized in the emergency department or doctor’s office

Next Steps

Follow-up

Most broken arms will not require admission to the hospital. For all other fractures, the treating doctor will suggest you follow up with an orthopedic doctor (bone specialist). At that time, the orthopedist will determine what further care (continued splinting, casting, or surgery) is necessary based on the type of fracture.

Additional follow-up instructions for fractures include the following:

·                                 Wear any support device (splint, sling, or brace, for example) until the doctor sees you for follow-up.

·                                 Keep your splint or cast clean and dry.

·                                 Apply ice to the injured area for 20-30 minutes 4-5 times a day.

·                                 Keep your arm elevated above the heart as much as possible to decrease swelling. Use pillows to prop your arm while in bed or sitting in a chair.

·                                 Take pain medicine as prescribed. Do not drink or drive if you are taking narcotic pain medication.

·                                 Call your doctor for increased pain, loss of sensation, or if your fingers or hand turn cold or blue.