Anatomic reduction of the fracture is usually successful in reducing the dislocations associated with Galleazi or Monteggia fractures. Intramedullary nailing is rarely used in adults. External fixators may be indicated for contaminated open fractures and fractures with significant soft-tissue compromise. Closed reduction is reserved for those with contraindications to surgical treatment, and unsatisfactory results may be expected up to 71% of the time. Most fractures of the radius and ulna in adults are displaced, and open reduction and internal fixation is the treatment of choice. Eponyms are associated with various fracture patterns: nightstick fractures refer to isolated ulnar shaft fractures Monteggia fractures are ulnar shaft fractures with radial head dislocation Galeazzi fractures are distal third radius fractures with dislocation of the DRUJ. CT may be helpful in evaluating the DRUJ.įractures are described by location within the bone (divided into thirds), displacement, angulation, and pattern. Radiographs of the opposite forearm may be useful in evaluating alignment. AP and lateral radiographs of the forearm, wrist and elbow should be obtained while the fractures will usually be evident, subtle malalignment of the DRUJ and radial head should be evaluated. A careful neurovascular exam should be documented, and repeat neurovascular exams are important, as these injuries are susceptible to compartment syndrome. Tenderness to palpation and crepitus may be elicited, but are usually unnecessary for diagnosis. On exam, pain and deformity are usually obvious. This bow is important in allowing the radius to rotate around the ulna in pronation and supination. The radius bows laterally approximately 15mm at its midpoint. The interosseous ligament or membrane runs between the bones, and helps maintain their relative positions, with a strong central band providing the majority of the support. Distally, they contact each other at the distal radioulnar joint (DRUJ), which is stabilized by the triangular fibrocartilage complex (TFCC). These bones are in contact proximally at the proximal radioulnar joint, where they are bound by the elbow joint capsule and the annular ligament, which wraps around the radial neck. The forearm is composed of the relatively straight ulna and the bowed radius. Fracture of one or both of the radius or ulna may be seen, along with various patterns of dislocation. Purely a motor syndrome resulting in finger drop, and radial wrist deviation on extension.Fractures of the shaft of the radius and ulna usually occur from a direct blow to the arm, as in a motor vehicle accident, motorcycle accident, assault, gunshot, or sports-related, or in a fall from a height.Posterior Interosseous Neuropathy (PIN) - radial nerve branch affects ~10% of Monteggia fractures.Consider open fracture (look for puncture wounds).If splinted and stabilized, can be discharged after consultation with Ortho.Long arm posterior splint with 90 degrees of elbow flexion and the hand in a neutral position.Findings: Radial head dislocation + proximal ulna fracture or plastic deformation of the ulna without obvious fracture.Assess radiocapitellar line on every lateral radiograph of the elbow: a line down the radial shaft should pass through the center of the capitellar ossification center.Radial head can dislocate anterior, posterior, or laterally.proximal 1/3 Ulna fracture + radial head dislocation (due to ulna shortening).CT scan: Fractures involving coronoid, olecranon, and radial head.Xray: AP, Lateral of elbow, forearm, wrist.PIN neuropathy most commonly associated (hand deviates radially with wrist extension).Decreased ROM at elbow may indicate dislocation.X-ray of Monteggia fracture of right forearm, showing fracture of ulna and dislocation of radius. May be associated with radial nerve injury (wrist drop, inability to extend the fingers)ĭifferential Diagnosis Forearm Fracture Types.Spontaneous relocation possible: must palpate directly over.Radial head may be palpable in an anterolateral or posterolateral location.Easy to overlook the radial head dislocation (will result in worse outcome).Common in kids (different treatment for kids) rare in adults.Proximal ulna fx with radial head dislocation.
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