Marvin is a healthy, active 36-year-old who belongs to a martial arts club. Once a week he takes lessons in Judo, and on the weekends, he participates in local competitions

Question

At his last competition, Marvin was paired with a skilled participant from another club. His rival threw him to the mats, and as Marvin struggled, came down hard to pin him down. Marvin heard a snap, followed by instant pain in his left forearm. Radiographs at the local hospital confirmed he suffered a transverse fracture of the distal aspect of his left ulna.

What are the typical signs and symptoms of a fracture? Why shortly after the injury does the pain temporarily subside?

How does a hematoma form, and what function does it serve in the process of healing a fracture?

Marvin was told he would be seeing a physiotherapist as his healing progressed. What are the muscular and joint changes that occur during immobilization and the ways Marvin and his physiotherapist can work to address these changes?

Answer 1

The typical signs and symptoms of a fracture include pain, swelling, and loss of function. If long bones are involved, the deformity results from the angulation, rotation, or shortening of the involved bone. Typically, abnormal mobility is also evident at the site of injury.
A decrease in the feeling of pain shortly after the injury is termed local shock. It involves a temporary interruption of neural function at the fracture site so that both sensory and motor activity is lost.

A hematoma forms from the blood that escapes from the torn vessels of the injured periosteum and surrounding soft tissues. It encircles and invades the fracture site to deliver clotting factors so that a fibrin network can be laid down. This network forms a foundation for fibroblast activity and the migration of new capillary buds. The hematoma also contains activated inflammatory cells and platelets. The growth factors released from these cells stimulate the proliferation of osteoclasts and osteoblasts for the deposition and remodeling of new bone.

The immobilization necessary for fracture healing also promotes joint stiffness through tendon shortening and disuse atrophy of the muscles. The cast is therefore removed as soon as possible to minimize the negative effects of immobilization. Exercises introduced early in the healing process help to maintain tissue integrity and are done bilaterally. A thorough rehabilitation program would include a full range of motion exercises for his unaffected arm and isometric (or muscle-tensing) exercises for his affected arm.