Download Fractures of forearm bones

Fractures of
forearm
bones
Fracture both bones forearm
Monteggia fracture dislocation
Galeazzi fracture dislocation
Vivek pandey
Fracture of Forearm Bones
Mechanism of Injury:
 Direct injury
 Fall on outstretched hand
 Twisting injury.
C/F:
 Pain, swelling, deformity & loss of function
 Bony tenderness, abnormal mobility
Diagnosis: Plain xray forearm- AP and Lateral view
Treatment:
The basis of treatment of forearm bone # is based upon a fact that a malunited
or nonunited # of forearm leads to
 Unacceptable deformity
 Loss of pronation and supination leading to loss of rotation of forearm
Fractures of forearm
Complication:
Acute- Compartment syndrome
Chronic1. Malunion: decreased pronation & supination
2. Cross union: NO pronation/supination
3. Non union
Indication for ORIF in forearm fractures

Monteggia and Galeazzi #
 All displaced # in adults
 All isolated displaced # radius
 Ulnar # with angulation > 100
Monteggia fracture dislocation (MFD)
Definition: Fracture of upper third of shaft ulna with dislocation of superior
radioulnar joint (SRUJ).
Mechanism of injury: fall on outstretched with full pronation
C/F:
1. Typical features of fracture
2. Always look for posterior interosseous nerve (PIN) palsy: inability to
extend MCP joint and thumb.
[PIN palsy happens due to stretching of nerve which winds around the neck of
radius, and the head of radius dislocates leading to stretching of the nerve]
Normal relation
of SRUJ with PIN
Investigations:
Plain x-ray of forearm: AP, Lateral view
IN MFD, the PIN is stretched
along dislocated radial head
Treatment:
The most important aspect of treatment of MFD is restoring the length of
fracture of Ulna. This promptly reduces the head of radius into the SRUJ.
1. In children: CR and AE cast application can be attempted if CR is
satisfactory. Maintain cast for 4-6 weeks.
2. IN adults:
There is NO conservative treatment of MFD.
It needs ORIF by plate. (3.5 mm DCP)
Followed by above elbow (AE) cast for 3 weeks.
Galeazzi fracture dislocation
Definition: Fracture at junction of middle/lower 1/3rd of radial shaft with
dislocation of inferior radioulnar joint (IRUJ).
MOI: fall on outstretched hand with full supination
Investigation: Plain x-ray of forearm: AP and lateral view
Treatment:
1. Children: CR of radius leads to spontaneous reduction of IRUJ into place
followed by AE cast for 6 weeks.
2. Adults:
 ORIF by DCP
 Unstable IRUJ can be transfixed by K wire (removed between 3-6
weeks)