Forearm fracture: Difference between revisions
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**Fractures usually occur at two or more sites or also involve a ligamentous injury | **Fractures usually occur at two or more sites or also involve a ligamentous injury | ||
==Both Bone== | |||
===Background=== | |||
*Requires great amount of force (vehicular trauma, falls from height, direct blow) | *Requires great amount of force (vehicular trauma, falls from height, direct blow) | ||
*Neurovascular complications are unusual | *Neurovascular complications are unusual | ||
===Imaging=== | |||
*Always consider wrist and elbow films | *Always consider wrist and elbow films | ||
*Assess for angulation | *Assess for angulation | ||
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**Lateral view: ulnar styloid and coronoid process normally point in opposite directions | **Lateral view: ulnar styloid and coronoid process normally point in opposite directions | ||
===Management=== | |||
*Rule-out compartment syndrome | *Rule-out compartment syndrome | ||
*ORIF | *ORIF | ||
==Isolated Radius (proximal)== | |||
===Background=== | |||
*Rare | *Rare | ||
*When occur, most are displaced | *When occur, most are displaced | ||
*Compartment syndrome is rare | *Compartment syndrome is rare | ||
===Management=== | |||
*Nondisplaced: cast immobilization | *Nondisplaced: cast immobilization | ||
*Displaced: Internal fixation | *Displaced: Internal fixation | ||
==Isolated Ulna (Nightstick)== | |||
===Background=== | |||
*Most often due to direct trauma | *Most often due to direct trauma | ||
===Management=== | |||
*Stable: short arm cast | *Stable: short arm cast | ||
*Unstable: ORIF | *Unstable: ORIF | ||
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**Involvement of proximal 1/3 | **Involvement of proximal 1/3 | ||
==Monteggia Fracture-Dislocation== | |||
===Background=== | |||
*Ulna fx (proximal third) + radial head dislocation | *Ulna fx (proximal third) + radial head dislocation | ||
*Easy to overlook the radial head dislocation (will result in worse outcome) | *Easy to overlook the radial head dislocation (will result in worse outcome) | ||
===Clinical Features=== | |||
*Pain/swelling at elbow | *Pain/swelling at elbow | ||
*Radial head may be palpable in an anterolatera or posterolateral location | *Radial head may be palpable in an anterolatera or posterolateral location | ||
===Management=== | |||
*Consult ortho in the ED; likely requires ORIF | *Consult ortho in the ED; likely requires ORIF | ||
==Galeazzi Fracture-Dislocation== | |||
===Background=== | |||
*Radius fx (distal third) + distal radioulnar dislocation | *Radius fx (distal third) + distal radioulnar dislocation | ||
*Caused by FOOSH or direct blow | *Caused by FOOSH or direct blow | ||
===Clinical Features=== | |||
*Localized tenderness/swelling over distal radius/wrist | *Localized tenderness/swelling over distal radius/wrist | ||
===Diagnosis=== | |||
*PA: May only show slightly increased distal radioulnar joint space | *PA: May only show slightly increased distal radioulnar joint space | ||
*Lateral: Ulna is displaced dorsally | *Lateral: Ulna is displaced dorsally | ||
===Management=== | |||
*Consult ortho in the ED; likely requires ORIF | *Consult ortho in the ED; likely requires ORIF | ||
Revision as of 22:58, 9 February 2012
Background
- Solitary fractures of the forearm are uncommon
- Fractures usually occur at two or more sites or also involve a ligamentous injury
Both Bone
Background
- Requires great amount of force (vehicular trauma, falls from height, direct blow)
- Neurovascular complications are unusual
Imaging
- Always consider wrist and elbow films
- Assess for angulation
- AP view: radial styloid and radial tuberosity normally point in opposite directions
- Lateral view: ulnar styloid and coronoid process normally point in opposite directions
Management
- Rule-out compartment syndrome
- ORIF
Isolated Radius (proximal)
Background
- Rare
- When occur, most are displaced
- Compartment syndrome is rare
Management
- Nondisplaced: cast immobilization
- Displaced: Internal fixation
Isolated Ulna (Nightstick)
Background
- Most often due to direct trauma
Management
- Stable: short arm cast
- Unstable: ORIF
- >50% displacement
- >10% angulation
- Involvement of proximal 1/3
Monteggia Fracture-Dislocation
Background
- Ulna fx (proximal third) + radial head dislocation
- Easy to overlook the radial head dislocation (will result in worse outcome)
Clinical Features
- Pain/swelling at elbow
- Radial head may be palpable in an anterolatera or posterolateral location
Management
- Consult ortho in the ED; likely requires ORIF
Galeazzi Fracture-Dislocation
Background
- Radius fx (distal third) + distal radioulnar dislocation
- Caused by FOOSH or direct blow
Clinical Features
- Localized tenderness/swelling over distal radius/wrist
Diagnosis
- PA: May only show slightly increased distal radioulnar joint space
- Lateral: Ulna is displaced dorsally
Management
- Consult ortho in the ED; likely requires ORIF
Source
- Tintinalli