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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 .

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Injuries of the forearm

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  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

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