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Chapter: Orthopaedics

Orthopaedics: Forearm

Orthopaedics: Forearm
1. Radius and Ulna Fracture 2. Monteggia Fracture 3. Nightstick Fracture 4. Galeazzi Fracture



Radius and Ulna Fracture




·                 commonly a FOOSH or direct blow



·                 x-ray: 1) AP and lateral of forearm; 2) AP, lateral, oblique of elbow and wrist

·                 CT if fracture is close to joint



·                 goal is anatomic reduction since imperfect alignment significantly limits forearm pronation and supination

·                 ORIF with compresslon plates and screws


Monteggia Fracture



·                 fracture of the proximal ulna with radial head dislocation



·                 direct blow on the posterior aspect of the forearm.

·                 hyperpronation

·                 fall on the hyperextended elbow


Clinical Features

·                 decreased rotation of forearm ± palpation lump at the radial head

·                 ulna angled apex anterior and radial head dislocated anteriorly (rarely the reverie deformity occurs)



·                 ORIF of ulna with indirect radius reduction in 90%

·                 splint and early post-op ROM if elbow completely stable; otherwise immobilization in plaster with elbow flexed for 6 weeks


Specific Complications (see General Fracture Complications)

·                 compartment syndrome

·                 radial/posterior interosseous nerve (PIN) injury

·                 decreased ROM


Nightstick Fracture



·                 isolated fracture of ulna



·                 direct blow to forearm (holding arm up to protect face)



·                 non-displaced: below elbow cast (10 days) followed by forearm brace (-8 weeks)

·                 displaced: ORIF if >5096 shaft displacement or >10° angulation


Galeazzi Fracture



·                 fracture of the distal radial shaft with disruption of the distal radioulnar joint (DRUJ)

·                 most commonly in the distall 1/3 of radius near junction of metaphysis/diaphysis



·                 usual cause is fall on the hand (mechanical axial loading ofpronated forearm)



·                 x-rays

o       shortening of distal radius >5 mm relative to the distal ulna

o       widening of the DRUJ space on AP

o       dislocation of radius with respect to ulna on true lateral



·                 ORIF of radius

·                 if DRUJ is stable, splint with early ROM

·                 if DRUJ ill unstable, DRUJ pinning and long arm cast in supination x 6 weeks


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