Download MBBS Orthopaedics PPT 6 Forearm Fracture And Wrist Injuries Lecture Notes

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ANATOMY

Two bones- radius and ulna

Three joints ? superior radio-ulnar joint

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inferior radio- ulnar joint

middle radio-ulnar joint

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(interosseous memberane)

Two articulations- elbow in proximal part

wrist in distal part

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EPIDEMIOLOGY

Common in men then in women

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Second most common after leg ?

cause of open fracture

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Causes- road traffic accidents

fall from height
sports injury

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MECHANISM OF INJURY

Direct- protecting oneself from

injury or assault

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Indirect injury-fall on

outstretched hand

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APPLIED ANATOMY

Forearm acts as a continuous ring

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Injury to one bone

Shortening

Fracture or dislocation of other

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bone

APPLIED ANATOMY

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Fracture of radius
Distal to supinator and proximal to

pronator teres- proximal segment goes into

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supination

Middle one-third? neutral position

Distal to pronator quadratus- proximal

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fragment goes into pronation


APPLIED ANATOMY

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Ulna provide an axis around which

laterally bowed radius rotates

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Supination and pronation

CLINICAL FEATURES

Pain

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Swel ing

Deformity

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Loss of hand and forearm function

Associated ulnar/ radial artery injury

Associated median/ ulnar/ radial nerve injury

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Associated compartment syndrome
RADIOGRAPHS

Standard AP and lateral views to

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be taken including wrist and

elbow

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CLASSIFICATION

It can be in terms of
? Closed or open
? According to location- proximal third

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Middle third

Distal third
? Anatomical- transverse, oblique, segmental

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or comminuted


TREATMENT

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Non operative treatment in the form of

above elbow cast with elbow at 900.

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Position of the forearm depended on

whether the fracture is in proximal ,

middle or distal part.

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The immobilization was done for 6-8

weeks

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TREATMENT

Surgical treatment-
Open/closed reduction and

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internal fixation with
Nailing
Plating

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TREATMENT

For open fractures

Follow the principle of open injuries

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Thorough wash
Debridement
Wound toileting
External fixation/ internal fixation

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COMPLICATIONS

? Infection

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? Non union

? Mal-union

? Neuro-vascular injury

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? Volkmann ischemia

? Re-fracture if plates removed early

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? Post traumatic radio-ulnar synostosis


MONTEGGIA FRACTURE DISLOCATION

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Injury to proximal one-third of

ulna with radial head dislocation

Mechanism of injury- as a result of fall

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on outstretched hand with forearm in hyper

pronation.

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Fracture of ulna and pushing radial head out of

the ligament sleeve

CLINICAL FEATURES

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Increase ulnar bow with sign of fracture

Radial head dislocated from is usual

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position

May be associated with PIN injury

showing absent finger and thumb

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extension.


RADIOLOGICAL EVALUATION

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Standard AP and Lateral view to

be taken

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CLASSIFICATION

Bado classification

Types depend on the displacement of

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radial head
TREATMENT

Non operative treatment can be

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tried in children

Above elbow cast in supination

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Check x-ray need to be done for

seeing the stability of radial head

in its place

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