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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)