Forearm Injury Flashcards
Learning Outcome:
- Radial and ulna shaft fracture
- Monteggia fracture
- Galeazzi fracture
- Distal radius fracture
- Colles fracture
- Smith’s fracture
- Chaffeur’s fracture
- Barton’s fracture
- Die-Punched fracture - Scaphoid fracture
- Lunate fracture
- Metacarpal fracture
- 1st metacarpal (intraarticular, extraarticular)
- 2nd-5th metacarpal (Head, neck, base, shaft) - Phalangeal fracture
- distal (Mellet, tuft, shaft, avulsion)
- proximal - Extensor tendon injury
- eight zones (communicate, pathology) laceration wound only
- six compartment - Flexor tendon injury
- five zones
- five annular lig.
- three cruciate lig.
vincular
osseus
synovial fluid
tenodesis effect
forearm compression
normal cascade
early - 2 weeks primary repair
late- tendon reconstruct or joint fusion
Radial and Ulnar Shaft Fracture pathology
- Epidemiology
- more common in men - Mechanism of injury
- fall on outstretched hand, twisting
- direct blow - Associated injury
- DRUJ, elbow (Galeazi, Monteggia)
- compartment syndrome - Classification
- open/closed
- discription as normal long bone fracture
Monteggia Fracture pathology
- Definition: Proximal or middle third ulna fracture associated with radiocapitellar joint dislocation
- Epidemiology:
more common in children - Mechanism of injury:
- fall on outstretched hand with pronated forearm
- self-defense injury - Bado Classification:
Type I - fracture of ulnar with anterior angulation and anterior dislocation of radial head (60%)
Type II - fracture of ulnar with posterior angulation and posterior dislocation of radial head (15%)
Type III - fracture of ulnar with radial angulation and lateral dislocation of radial head (20%)
Type IV - fracture of ulnar with anterior angulation and anterior dislocation of radial head and fracture of proximal third of radius (5%) - Associated injury
- PIN injury
- compartment syndrome
Monteggia Fracture diagnosis
Hx
- trauma: fall on outstretched hand with pronated forearm, self-defense injury
- sx of fracture
Pe
- signs of fracture
- TRO PIN injury
X-ray
- AP: lateral displacement
- lateral: AP displacement, angulation. Radial head, shaft do not point to capitulum
Galeazzi Fracture pathology
- Definition: Fracture of distal third of ulnar with DRUJ subluxation/dislocation
- Epidemiology: more common than Monteggia fracture
- Mechanism of injury:
- direct blow to wrist
- fall on outstretched
hand with pronated/supinated forearm - The closer the fracture to DRUJ, the higher the DRUJ instability
Associated injury
- ligament injury
- fracture of styloid process of ulna
Galeazzi Fracture diagnosis
Hx
- trauma: fall on outstretched hand with pronated forearm or direct blow
Pe
- signs of fracture
- ballot the distal end of ulna “piano key sign”
- TRO ulnar nerve injury
- radial shortening >5mm (ulnar +)
X-ray
- AP: widening of DRUJ, radial shortening
- lateral: AP displacement, angulation
Colles Fracture pathology
- Definition: Fracture of distal radius with dorsal displacement
- Epidemiology: more common in elderly, post menopause
- Mechanism: Fall on outstretched hand
- Associated injury
- median nerve compression carpal tunnel
- ulnar styloid fracture (triangular fibrocartilage complex injury)
- EPL injuy
Colles Fracture diagnosis
Hx
- trauma: fall on outstretched hand
Pe
- signs of fracture
- dorsal displacement
- radial tilt
- radial shortening (ulnar +)
- dinner-fork deformity (prominence on the back of the wrist with depression in front)
X-ray
- distal radius fracture with dorsal displacement
- extraarticular
- osteoporotic bone
Smith’s Fracture pathology
- Definition: Distal radius fracture with volar displacement
- Mechanism of injury: fall on back of the hand
Smith’s fracture diagnosis
Hx
- trauma: fall on back of the hand
Pe
- signs of fracture
- volar displacement
- radial tilt
- radial shortening (ulnar +)
- garden spade deformity (prominence on the volar of the wrist with depression at the back)
X-ray
- distal radius fracture with volar displacement
Chauffeur’s Fracture pathology
- Definition: Radial styloid fracture (extending from articular surface laterally)
- Mechanism of injury: forced radial deviation of the wrist
- Associated injury: trans-scaphoid perilunate fracture
Barton’s fracture pathology
- Definition: intraarticular fracture of distal radius with dislocation of radiocarpal joint
- Type:
- dorsal barton
- volar barton (more common)
Scaphoid fracture pathology
- Epidemiology:
- most common carpal bone injury
- rare in adult and children - Mechanism of injury: fall on outstretched hand
- Vascular supply: diminishes proximally (retrograde supply)
- proximal: 40% non union
- middle: 20% non union
- distal: 1% non union
* major: dorsal carpal branch (radial art)
* minor: sup. palmar arch (radial art)
Scaphoid fracture diagnosis
Hx
- trauma: fall on outstretched hand
- pain, swelling in snuffbox (dorsum), scaphoid tubercle (volar)
X-Ray
I. AP:
*bean-shaped scaphoid (normal)
- inner circular opacity “cortical ring sign”
- squatted, foreshortened
II. Lateral:
*Radius, capitate, middle metacarpal in straight line
*scaphoid axis at 45 degree to line of radius
- Dorsal intercalated segment instability (DISI)
III. Oblique/Scaphoid view
*30 degree wrist extension, 20 degree ulnar deviation
**repeat x-ray at 14-21 weeks if negative, but have high index of suspicion
Care of Amputation
finger
- wipe debris away
- put in plastic
- wrapped with gauze
- put in ice-packs
stump
- wash with normal saline
- compress with gauze (if proximal use tourniquet)
