1 / 36

Injuries of the forearm

Injuries of the forearm. By : Dr.Sanjeev. Monteggia Fracture Dislocation. Fracture upper third of ulna with dislocation head of the radius . Mechanism: More common in children fall on outstretched hands either in hyperpronation or in hyperextension .

lkidd
Télécharger la présentation

Injuries of the forearm

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Injuries of the forearm By : Dr.Sanjeev

  2. Monteggia Fracture Dislocation. • Fracture upper third of ulna with dislocation head of the radius . Mechanism: • More common in children • fall on outstretched hands either in hyperpronation or in hyperextension . • C / F : - Pain , Swelling, deformity, severe loss of forearm movement. • Radiology : AP, lateral.

  3. . • Fig : -

  4. Classification • Type 1 (60%) : anterior dislocation of head of the radius with fracture ulna at upper third and with anterior angulation. • Type 2 (5%) : posterior dislocation head of the radius and fracture proximal ulna with posterior angulation. • Type 3 (20%) : lateral dislocation head of the radius and fracture proximal ulna with lateral angulation. • Type 4 (15%) : fracture radius and ulna in their upper one – third and anterior dislocation of head of the radius with anterior angulation.

  5. Cont.. • Fig : - Type 1:

  6. Cont.. • Fig : - Type 2 :

  7. Cont.. • Fig : - Type 3

  8. Cont.. • Fig : Type - 4

  9. Clinical symptoms : Type 1 , Type 2 , Type 3 and Type 4 : • Marked pain and tenderness about the elbow • No flexion , extension , pronation , and supination. • Paralysis of the interosseous nerve may occur.

  10. Clinical signs Type 1 : - HOR felt anteriorly - Anterior angulation Type 2 : - HOR posterior - Posterior angulation of ulna - Shortening of forearm Type 3 : - HOR is lateral - Lateral angulation Type 4 : - HOR is anterior - Deformity is at the fracture level (HOR = HEAD OF RADIUS)

  11. TREATMENT : In children • Type 1 : • Closed reduction (if fails) • OR of fracture ulna + CR of HOR (if fails) • OR of fracture ulna with OR of head of the radius Type 2 : • CR (closed reduction ) • OR (open reduction Type 3 : - CR

  12. CONT.. Type 4 : • CR (if fails ) • OR rigid IF with plate and screws IN ADULTS : (type 1, 2, 3 and 4) • OR + IF of fracture ulna with plate and screws • CR of HOR (if fails) • OR ,HOR +IF fracture ulna • If fracture more than 6 weeks excision HOR is done.

  13. Complications • Posterior interosseous nerve palsy . • Radial head instability • Nonunion of fracture ulna. • Malunion of fracture ulna. • Myositis ossificans

  14. Galeazzi fracture dislocation • Fracture of the radial shaft at the junction of middle and distal third with associated subluxation or dislocation of the distal radioulnar joint. • Reverse Monteggia • Also known as fracture of necessity (which requiresORIF)

  15. Forces causing loss of reduction and difficulty in reduction : • Insertion of pronator quadratus pulls the distal fragment in proximal and volar direction • Brachioradialis uses the distal radioulnar joint as a pivot and causes shortening

  16. Mechanism of injury : - . - Direct blow on the dorsolateral side of the forearm - Fall on an outstretched hand with marked pronation of the forearm .

  17. Clinical features : • Pain, • swelling, • Deformity of the lower end of the forearm • Pronation and supination are severely restricted. • Neurovascular injury is rare.

  18. AP view : Fracture radius , transverse or short oblique Distal radioulnar joint is dislocated Radius appears short Lateral view : Radius is angulated dorsally Head of the ulna is prominent dorsally. Radiological :

  19. CONT.. FIG : AP - VIEW

  20. Cont… FIG : - LATERAL VIEW

  21. Treatment • ORIF(Plate and screw fixation). • Distal radio – ulnar joint stability..? • Yes plaster , • No K wire fixation.

  22. Complications • Malunion loss of supination/ pronation. (osteotomy). • Nonunion bone grafting. • Compartment syndrome. • Angulation of the fracture and subluxation of the distal radioulnar joint.

  23. Barton’s fracture • Fracture line extends from the distal articular surface of the radius. • Dislocation or subluxation usually associated. • Most are unstable. • ORIF.

  24. Cont.. • Fig : -

  25. Radial styloid fracture • Also known as chauffeur’s fracture; Hutchinson fracture. • Posterior marginal fracture of the radius • Avulsion fracture of the radiocarpal ligament • Seen in motorcycle accidients , and fall from heights

  26. Cont .. • Fig : Radial styloid fracture

  27. Clinical features • Pain • Swelling • Tenderness over the radial styloid process • Movement of the wrist, especially radial deviation , is painful Radiology : • AP – shows transverse fracture

  28. Treatment • Closed reduction and above elbow plaster cast Unstable fractures : • percutaneous with K - wire

  29. Cont.. • Fig : long armed cast

More Related