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

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Orthopaedics PPT 6 Forearm Fracture And Wrist Injuries Lecture Notes

FOREARM FRACTURE AND

WRIST INJURIES

ANATOMY

Two bones- radius and ulna

Three joints ? superior radio-ulnar joint

inferior radio- ulnar joint

middle radio-ulnar joint

(interosseous memberane)

Two articulations- elbow in proximal part

wrist in distal part


EPIDEMIOLOGY

Common in men then in women

Second most common after leg ?

cause of open fracture

Causes- road traffic accidents

fall from height
sports injury

MECHANISM OF INJURY

Direct- protecting oneself from

injury or assault

Indirect injury-fall on

outstretched hand


APPLIED ANATOMY

Forearm acts as a continuous ring

Injury to one bone

Shortening

Fracture or dislocation of other

bone

APPLIED ANATOMY

Fracture of radius
Distal to supinator and proximal to

pronator teres- proximal segment goes into

supination

Middle one-third? neutral position

Distal to pronator quadratus- proximal

fragment goes into pronation


APPLIED ANATOMY

Ulna provide an axis around which

laterally bowed radius rotates

Supination and pronation

CLINICAL FEATURES

Pain

Swel ing

Deformity

Loss of hand and forearm function

Associated ulnar/ radial artery injury

Associated median/ ulnar/ radial nerve injury

Associated compartment syndrome
RADIOGRAPHS

Standard AP and lateral views to

be taken including wrist and

elbow

CLASSIFICATION

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

Middle third

Distal third
? Anatomical- transverse, oblique, segmental

or comminuted


TREATMENT

Non operative treatment in the form of

above elbow cast with elbow at 900.

Position of the forearm depended on

whether the fracture is in proximal ,

middle or distal part.

The immobilization was done for 6-8

weeks

TREATMENT

Surgical treatment-
Open/closed reduction and

internal fixation with
Nailing
Plating


TREATMENT

For open fractures

Follow the principle of open injuries

Thorough wash
Debridement
Wound toileting
External fixation/ internal fixation

COMPLICATIONS

? Infection

? Non union

? Mal-union

? Neuro-vascular injury

? Volkmann ischemia

? Re-fracture if plates removed early

? Post traumatic radio-ulnar synostosis


MONTEGGIA FRACTURE DISLOCATION

Injury to proximal one-third of

ulna with radial head dislocation

Mechanism of injury- as a result of fall

on outstretched hand with forearm in hyper

pronation.

Fracture of ulna and pushing radial head out of

the ligament sleeve

CLINICAL FEATURES

Increase ulnar bow with sign of fracture

Radial head dislocated from is usual

position

May be associated with PIN injury

showing absent finger and thumb

extension.


RADIOLOGICAL EVALUATION

Standard AP and Lateral view to

be taken

CLASSIFICATION

Bado classification

Types depend on the displacement of

radial head
TREATMENT

Non operative treatment can be

tried in children

Above elbow cast in supination

Check x-ray need to be done for

seeing the stability of radial head

in its place