Forearm fractures


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

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. coronoideus (st. 1-3);
 * 3) fractures of the diaphysis of the radius and ulna:
 * 4) * associated fractures of the radius and ulna;;
 * 5) * isolated fractures of the radius and ulna;
 * 6) * Monteggia fracture;
 * 7) * Galeazzi fracture;
 * 8) fractures of the distal radius:
 * 9) * extraarticular:
 * 10) ** no dislocation;
 * 11) ** with extensional dislocation (Colles fracture);
 * 12) ** with flexion dislocation (Smith's fracture);
 * 13) * partially intra-articular:
 * 14) ** sagittal dislocation;
 * 15) ** dorsal dislocation (Barton I);
 * 16) ** ventral edge avulsion (Barton II);
 * 17) * intra-articular comminuted (Melon).

Complications

 * Pseudoarthrosis;
 * compartment syndrome;
 * Volkmann's ischemic contracture;
 * synostosis between radius and ulna.

Conservative

 * Possible for non-displaced 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, in pronation in the lower half, for 12-16 weeks).
 * For isolated fractures of one forearm, cast fixation for 8 weeks - for non-isolated fractures of the ulna and upper two-thirds of the radius (in supination), fractures of the lower third of the radius indicated for operative treatment.
 * For fractures of the distal radius (Colles, Smith), plaster fixation for 6 weeks - from the metacarpal heads below the elbow, with the wrist in ulnar duction and flexion (Colles) or extension (Smith).

Surgical

 * Recommended for isolated fractures (the second, unbroken bone then acts as a spacer and leads to the formation of a subluxation); Galeazzi and Monteggi fractures are also indicated, as are all dislocated and open fractures.
 * Autocompression splints and intra-articular fixation with spikes are mainly used, external fixation in open and splinter fractures, splints, K-wires, screws, external fixation in distal forearm fractures.

Related articles

 * Ulna
 * Radius