Forearm Fractures

Question 1

Outline the important anatomy when considering forearm fractures.

Answer 1

• The radius & ulna acted as a rigid frame, attached by:
• Elbow joint
• Distal radio-ulnar joint (DRUJ)
• Interosseous membrane the whole length of the
forearm

Question 2

Displaced shaft fractures are often associated with… (two answers)

Answer 2

• Fracture of the other forearm bone shaft

* Dislocation of the other bone’s joint

Question 3

Why are the whole of the forearm bone shafts (radius and ulna) considered an articulating surface and why is this important in forearm fractures?

Answer 3

• Supination & pronation require the radial & ulnar
shafts to glide over each other in close proximity,
even slight displacement in the shafts of these
bones can cause loss of rotatory movement
• Therefore the whole of the forearm bone shafts
should be considered as an articulating surface
• Reduction must be perfect (as any intra-articular
fracture) –> therefore requiring ORIF

Question 4

Outline the main forearm fracture patterns.

Answer 4

• Fracture of radial and ulnar shafts = forearm fracture
• Fracture of proximal ulna with dislocation of radial head (at elbow) = MONTEGGIA
• Fracture of radial shaft with dislocation of the ulnar head at the DRUJ (at wrist) = GALEAZZI
• Isolated ulnar shaft fracture (from direct blow) = NIGHTSTICK FRACTURE

Question 5

What is a Monteggia fracture?

Answer 5

Fracture of proximal ulna with dislocation of radial head (at elbow).

Question 6

What is a Galeazzi fracture?

Answer 6

Fracture of radial shaft with dislocation of the ulnar head at the DRUJ (at wrist).

Question 7

What is a Nightstick fracture?

Answer 7

Isolated ulnar shaft fracture (from direct blow).

Question 8

What is the most common mechanism/aetiology of forearm fractures?

Answer 8

• FOOSH (high energy)

- Usually a sporting injury

Question 9

What are important considerations in examining a forearm fracture?

Answer 9

• Neurovasculature: median nerve (and anterior interosseous nerve); radial nerve (and posterior interosseous nerve); ulnar nerve.
• Open/closed injury
• Other sites of injury in the same limb

Question 10

What imaging modalities are required in a forearm fracture?

Answer 10

• X-rays : AP & lateral of forearm, with separate AP & lateral of elbow; AP & lateral of wrist often required.
• +/- CT if comminuted.

Question 11

How are forearm/Monteggia/Galeazzi/isolated ulnar or radial fractures managed?

Answer 11

• General anaesthetic
• Open reduction
• Internal fixation of fracture +/- reduction of any joint dislocation

Question 12

Why are nearly all adult forearm fractures managed via ORIF?

Answer 12

• Displacement is often quite marked.
• Rotational deformities are frequent.
• Majority require ORIF as closed reduction is
generally unsuccessful & does not achieve
perfect reduction

Question 13

What is the most common mechanism/aetiology of an isolated ulnar fracture/Nightstick fracture?

Answer 13

• Clue is in the name
• Usually a result of direct violence
• Warding off a blow from a stick/falling object/falling onto a step or chair back

Question 14

In imaging a forearm fracture what are the two important locations to image?

Answer 14

• ALWAYS view the elbow and the wrist (and be aware of odd combinations)

Question 15

NOTE TO SELF: PLEASE LOOK AT IMAGES OF FOREARM FRACTURE/MONTEGGIA/GALEAZZI/NIGHTSTICK FRACTURES

Answer 15

You can do it, Bruce!