Fractures of the forearm


 * They are formed by the mechanism:
 * direct – only one bone can be injured;
 * indirect – always injured both bones or Monteggi and Galeazzi.
 * Dislocation of the radius according to the height of the fracture:
 * in the upper third – the pull of the supinator and biceps;
 * in the lower third – pronator pull.

Classification

 * 1) Fractures of the proximal radius – head fractures (Mason I–III), neck fractures;
 * 2) fractures of the proximal ulna – fractures of the olecranon (Colton I–III), fracture of the proc. coronoid (st. 1–3);
 * 3) fractures of the diaphysis of the radius and ulna:
 * 4) * compound fractures of the radius and ulna;
 * 5) * isolated fractures of the radius and ulna;
 * 6) * Monteggio's fracture;
 * 7) * Galeazzi's fracture;
 * 8) fractures of the distal radius:
 * 9) * extra-articular:
 * 10) ** without dislocation;
 * 11) ** with extension dislocation ( Colles fracture );
 * 12) ** with flexion dislocation ( Smith's fracture );
 * 13) * partially intra-articular:
 * 14) ** sagittal break-off;
 * 15) ** dorsal break-off (Barton I);
 * 16) ** break-off of ventral edge (Barton II);
 * 17) * intra-articular comminutive (Melon).

Complications

 * Pakloub;
 * compartment syndrom;
 * Volkmann ischemic contraction;
 * synostosis between radius and ulna.

Conservative

 * Possibly for non-dislocated fractures of both bones (circular cast fixation from mid-arm to metacarpal heads, elbow in 90° flexion, forearm in supination for fractures in the upper half, pronation in the lower half, for 12-16 weeks).
 * For isolated fractures of one forearm bone, plaster fixation is required for 8 weeks - for non-dislocated fractures of the ulna and the upper two thirds of the radius (in supination), fractures of the lower third of the radius are indicated for surgical treatment.
 * For fractures of the distal radius (Colles, Smith), plaster fixation for 6 weeks - from the heads of the metacarpals to the elbow, with the wrist in ulnar adduction and flexion (Colles) or extension (Smith).

Operational

 * Recommended for isolated fractures (the second, unbroken bone then acts as a spacer and leads to the creation of a joint), Galeazzi and Monteggi fractures are also indicated, as well as all displaced and open fractures.
 * Self-compression splints and intramedullary nail fixation are mainly used, for open and comminuted fractures external fixation, for distal forearm fractures splints, K-wires, screws, external fixation.

related articles

 * Ulna
 * Radius

Source

 * PASTOR, Jan. Langenbeck's medical web page [online]. [cit. 2010]. .

Categories: Surgery TRAUMA | ORTHOPEDIC