Radius and Ulna Shaft Fractures Flashcards
Which bone has the highest ratio of open to closed injuries?
Tibia #2 is both bone forearm fractures
What are the five parts of the interosseous membrane?
1) central band; key portion of IOM to be reconstructed
2) accessory band
3) distal oblique bundle
4) proximal oblique cord
5) dorsal oblique accessory cord
What is the acceptable displacement of an isolated ulnar shaft (Nightstick) fracture?
1)
What is the most important variable in outcomes of ORIF of both bone forearm fractures?
Restoration of radial bow
When is bone grafting indicated during ORIF of both bone forearm fractures?
1) Segmental bone loss
2) Open injury with bone loss
3) Non union
What is the primary advantage of two incisions compared to one for open reduction internal fixation of a both bones forearm fracture?
Lowers risk of synostosis
What approaches are used for fixation of radial and ulnar shaft fractures?
Volar Henry:
Distal 1/3 (btw FCR and BR) to middle 1/3 (btw FCR and pronator teres) radius fractures
Dorsal Thompson:
Proximal 1/3 radius fractures
Proximally btw ECRB (radial n.) and EDC (PIN), distally btw ECRB (radial n.) and EPL (PIN)
Subcutaneous approach to the ulnar shaft btw FCU (ulnar n.) and ECU (PIN)
What complications are common with radial and ulnar shaft fractures?
1) Synostosis; 3-9%
2) Infection; 3%
3) Compartment syndrome; increased with high energy, GSW, crush injury
4) Refracture; do not remove plates before 15mths
How are atrophic non-unions of radial and ulnar shaft fractures treated?
3.5mm DCP plate and autogenous cancellous bone grafting
Excision of heterotopic bone about the forearm or elbow can be done with limited recurrence rates as early as which of the following after initial injury?
4-6 months if given XRT and/or indomethacin
What are risk factors for refracture after plate removal in both bone forearm fractures?
1) degree of initial displacement and comminution
2) Large 4.5mm plates
3) early removal; prior to 15mths
4) lack of postremoval protection; brace for 6wks after
Treatment of displaced, open both bone forearm fractures should consist of?
Irrigation and debridement, ORIF and primary closure
What are indications for the use of locked plates?
1) indirect fracture reduction
2) diaphyseal/metaphyseal fractures in osteoporotic bone
3) bridging severely comminuted fractures
4) plating of fractures where anatomical constraints prevent plating on the tension side of the bone
What size and location should be used in plating of a both bone forearm fracture?
Ulna can be plated on dorsal, volar (most common) or subcutaneous border
Radius can be plated on volar surface
Use 3.5mm plates, can use 2.7mm for distal ulna fxs
