FOREARM FRACTURE AND
WRIST INJURIES
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ANATOMYTwo 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 accidentsfall from height
sports injury
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MECHANISM OF INJURYDirect- 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 boneShortening
Fracture or dislocation of other
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bone
APPLIED ANATOMY
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Fracture of radiusDistal to supinator and proximal to
pronator teres- proximal segment goes into
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supinationMiddle 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 pronationCLINICAL FEATURES
Pain
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Swel ing
Deformity
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Loss of hand and forearm functionAssociated 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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CLASSIFICATIONIt 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 onwhether 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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TREATMENTSurgical treatment-
Open/closed reduction and
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internal fixation withNailing
Plating
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TREATMENTFor 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 synostosisMONTEGGIA FRACTURE DISLOCATION
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Injury to proximal one-third ofulna 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 ofthe 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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positionMay 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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CLASSIFICATIONBado 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 forseeing the stability of radial head
in its place
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