forearm fracture

Question 1

fractures with elbow involvement

Answer 1

Montaggia fracture: fracture of the proximal or middle ulna
dislocation of the radial head
Isolated radial head fracture: fracture of the radial head
olecranon fracture: fracture of the olecranon process

Question 2

fracture of the proximal or middle ulna with dislocation of the radial head

Answer 2

monteggia fracture

Question 3

mechanism of injury of monteggia fracture

Answer 3

fall onto outstretched and pronated forearm and extended wrist

Question 4

isolated ulna fracture

Answer 4

(parry fracture, nightstick fracture)
typically a defensive injury

Question 5

galeazzi fracture

Answer 5

radial shaft fracture
subluxation or dislcocation of the DRUJ
fall into an outstretched and pronated forearm and extended wrist

Question 6

colles fracture

Answer 6

radial and dorsal displacement of the distal fragment of the radius
FOOSH on extended wrist

Question 7

smith fracture

Answer 7

radial and volar displacement of the distal fragment of the radius
flexion fracture: fall onto palmar flexed wrist

Question 8

barton fracture

Answer 8

radial avulsion and dorsal displacement of the radiocarpal segment of the radius
extension fracture: FOOSH

Question 9

reverse barton fracture

Answer 9

avulsion and volar displacement of the radiocarpal segment
flexion fracture

Question 10

hutchinsion fracture

Answer 10

avulsion of the radial styloid
extension fracture FOOSH

Question 11

die punch fracture

Answer 11

intraarticular fracture of the lunate fossa of the distal radius
axial loading force applied against the distal radius

Question 12

initial management

Answer 12

neurovascular examination
consult ortho if needed
consider adding imaging of the elbow and wrist to check for associated injuries
evaluate for signs of compartment syndrome in any patient with high-energy trauma
analgesia for acute fractures

Question 13

indications to consult orthopaedics for fractures

Answer 13

skin tenting
open fractures
potentially operable long bone fractures
comminuted fractures
displaced intra-articular fractures
fracture-dislocations
unstable pelvic fractures
neurovascular compromise
compartment syndrome

Question 14

clinical features of a monteggia fracture

Answer 14

pain, crepitus, and limited range of motion at the elbow
radial head may be palpable at the antecubital fossa in anterior dislocation
shortened forearm
posterior interosseous nerve injury can occur
- paresthesias of the dorsal spects of the thumb, second and third fingers
- loss of thumb extension

Question 15

galeazzi fracture clinical features

Answer 15

pain and deformity of the distal radius
limited range of motion at the wrist
palpable displacement of the ulnar head
neurological injury is rare, but anterior interosseous nerve palsy can occur
almost all require open reduction