Radius and Ulna shaft fractures mechanism
- high-energy di ect or indirect (MVA, fall from height, sports) t auma
- fractures usually accompanied by displacement due to high force
Radius and Ulna shaft fractures clinical features
- deformity, pain, swelling
* loss of function in hand and forearm
Radius and Ulna shaft fractures investigations
- X-ray: AP and lateral of forearm ± oblique of elbow and wrist
- CT if fracture is close to joint
Radius and Ulna shaft fractures treatment
- goal is anatomic reduction since imperfect alignment significantly limits forearm pronation and supination
- ORIF with plates and screws; closed reduction with immobilization usually yields poor results for displaced forearm fractures (except in children)
Radius and Ulna shaft fractures specific complications
• soft tissue contracture resulting in limited forearm rotation – surgical release of tissue may be warranted
Monteggia Fracture mechanism
- direct blow on the posterior aspect of the forearm
- hyperpronation
- fall on the hyperextended elbow
Monteggia Fracture clinical features
- pain, swelling, decreased rotation of forearm ± palpable lump at the radial head
- ulna angled apex anterior and radial head dislocated anteriorly (rarely the reverse deformity occurs)
Monteggia Fracture investigations
• X-ray: AP, lateral elbow, wrist and forearm
Monteggia Fracture treatment
- adults: ORIF of ulna with indirect radius reduction in 90% of patients (ORIF of radius if unsuccessful)
- splint and early post-operative ROM if elbow completely stable, otherwise immobilization in plaster with elbow flexed for 6 wk
- pediatrics: attempt closed reduction and immobilization in plaster with elbow flexed for Bado Type I-III, surgery for Type IV
Monteggia Fracture specific complications
- PIN: most common nerve injury; observe for 3 mo as most resolve spontaneously
- radial head instability/redislocation
- radioulnar synostosis
Monteggia Fracture definition
fracture of the proximal ulna with radial head dislocation and proximal radioulnar joint injury
In all isolated ulna fractures, assess proximal radius to rule out a Monteggia fracture
Monteggia Fracture how does prognosis change with age
more common and better prognosis in the pediatric age group when compared to adults
Bado Type classification of Monteggia fractures
Based on the direction of displacement of the dislocated radial head, generally the same direction as the apex of the ulnar fracture
Type I: anterior dislocation of radial head and proximal/middle third ulnar fracture (60%)
Type II: posterior dislocation of radial head and proximal/middle third ulnar fracture (15%)
Type III: lateral dislocation of radial head and metaphyseal ulnar fracture (20%)
Type IV – combined: proximal fracture of the ulna and radius, dislocation of the radial head in any direction (<5%)
Nightstick fracture definition
isolated fracture of ulna without dislocation of radial head
Nightstick fracture mechanism
direct blow to forearm (e.g. holding arm up to protect face)
Nightstick fracture treatment
• non-operative
■ non-displaced
■ below elbow cast (x 10 d), followed by forearm brace (~8 wk)
• operative
■ displaced
■ ORIF if >50% shaft displacement or >10° angulation
Galeazzi Fracture definition
- fracture of the distal radial shaft with disruption of the DRUJ
- most commonly in the distal 1/3 of radius near junction of metaphysis/diaphysis
Galeazzi Fracture mechanism
• hand FOOSH with axial loading of pronated forearm or direct wrist trauma
Galeazzi Fracture clinical features
• pain, swelling, deformity, and point tenderness at fracture site
Galeazzi Fracture investigations
For all isolated radius fractures assess DRUJ to rule out a Galeazzi fracture
• X-ray: AP, lateral elbow, wrist, and forearm
■ shortening of distal radius >5 mm relative to the distal ulna
■ widening of the DRUJ space on AP
■ dislocation of radius with respect to ulna on true lateral
Galeazzi Fracture treatment
• all cases are operative
■ ORIF of radius; afterwards, assess DRUJ stability by balloting distal ulna relative to distal radius
■ if DRUJ is stable and reducible, splint for 10-14 d with early ROM encouraged
■ if DRUJ is unstable, ORIF or percutaneous pinning with long arm cast in supination x 6 wk
