Forearm

Question 1

Radius and Ulna shaft fractures mechanism

Answer 1

• high-energy di ect or indirect (MVA, fall from height, sports) t auma
• fractures usually accompanied by displacement due to high force

Question 2

Radius and Ulna shaft fractures clinical features

Answer 2

• deformity, pain, swelling

* loss of function in hand and forearm

Question 3

Radius and Ulna shaft fractures investigations

Answer 3

• X-ray: AP and lateral of forearm ± oblique of elbow and wrist
• CT if fracture is close to joint

Question 4

Radius and Ulna shaft fractures treatment

Answer 4

• goal is anatomic reduction since imperfect alignment significantly limits forearm pronation and supination
• ORIF with plates and screws; closed reduction with immobilization usually yields poor results for displaced forearm fractures (except in children)

Question 5

Radius and Ulna shaft fractures specific complications

Answer 5

• soft tissue contracture resulting in limited forearm rotation – surgical release of tissue may be warranted

Question 6

Monteggia Fracture mechanism

Answer 6

• direct blow on the posterior aspect of the forearm
• hyperpronation
• fall on the hyperextended elbow

Question 7

Monteggia Fracture clinical features

Answer 7

• pain, swelling, decreased rotation of forearm ± palpable lump at the radial head
• ulna angled apex anterior and radial head dislocated anteriorly (rarely the reverse deformity occurs)

Question 8

Monteggia Fracture investigations

Answer 8

• X-ray: AP, lateral elbow, wrist and forearm

Question 9

Monteggia Fracture treatment

Answer 9

• adults: ORIF of ulna with indirect radius reduction in 90% of patients (ORIF of radius if unsuccessful)
• splint and early post-operative ROM if elbow completely stable, otherwise immobilization in plaster with elbow flexed for 6 wk
• pediatrics: attempt closed reduction and immobilization in plaster with elbow flexed for Bado Type I-III, surgery for Type IV

Question 10

Monteggia Fracture specific complications

Answer 10

• PIN: most common nerve injury; observe for 3 mo as most resolve spontaneously
• radial head instability/redislocation
• radioulnar synostosis

Question 11

Monteggia Fracture definition

Answer 11

fracture of the proximal ulna with radial head dislocation and proximal radioulnar joint injury

In all isolated ulna fractures, assess proximal radius to rule out a Monteggia fracture

Question 12

Monteggia Fracture how does prognosis change with age

Answer 12

more common and better prognosis in the pediatric age group when compared to adults

Question 13

Bado Type classification of Monteggia fractures

Answer 13

Based on the direction of displacement of the dislocated radial head, generally the same direction as the apex of the ulnar fracture

Type I: anterior dislocation of radial head and proximal/middle third ulnar fracture (60%)

Type II: posterior dislocation of radial head and proximal/middle third ulnar fracture (15%)

Type III: lateral dislocation of radial head and metaphyseal ulnar fracture (20%)

Type IV – combined: proximal fracture of the ulna and radius, dislocation of the radial head in any direction (<5%)

Question 14

Nightstick fracture definition

Answer 14

isolated fracture of ulna without dislocation of radial head

Question 15

Nightstick fracture mechanism

Answer 15

direct blow to forearm (e.g. holding arm up to protect face)

Question 16

Nightstick fracture treatment

Answer 16

• non-operative
■ non-displaced
■ below elbow cast (x 10 d), followed by forearm brace (~8 wk)

• operative
■ displaced
■ ORIF if >50% shaft displacement or >10° angulation

Question 17

Galeazzi Fracture definition

Answer 17

• fracture of the distal radial shaft with disruption of the DRUJ
• most commonly in the distal 1/3 of radius near junction of metaphysis/diaphysis

Question 18

Galeazzi Fracture mechanism

Answer 18

• hand FOOSH with axial loading of pronated forearm or direct wrist trauma

Question 19

Galeazzi Fracture clinical features

Answer 19

• pain, swelling, deformity, and point tenderness at fracture site

Question 20

Galeazzi Fracture investigations

Answer 20

For all isolated radius fractures assess DRUJ to rule out a Galeazzi fracture

• X-ray: AP, lateral elbow, wrist, and forearm
■ shortening of distal radius >5 mm relative to the distal ulna
■ widening of the DRUJ space on AP
■ dislocation of radius with respect to ulna on true lateral

Question 21

Galeazzi Fracture treatment

Answer 21

• all cases are operative
■ ORIF of radius; afterwards, assess DRUJ stability by balloting distal ulna relative to distal radius
■ if DRUJ is stable and reducible, splint for 10-14 d with early ROM encouraged
■ if DRUJ is unstable, ORIF or percutaneous pinning with long arm cast in supination x 6 wk