Forearm fracture

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Background

  • Solitary fractures of the forearm are uncommon
    • Fractures usually occur at two or more sites or also involve a ligamentous injury

Fracture Types

=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