Case

• 
  

  Simple fracture of both bones fixed with LC-DCP 3.5

Introduction

• 
  

  The Müller AO/OTA Classification divides forearm shaft fractures into three types:

  
  
  
  
  • 
    

    type 22-A: simple fracture of one or two bones

    
    
  • 
    

    type 22-B: wedge fracture of one or two bones

    
    
  • 
    

    type 22-C: complex fracture of one bone and simple fracture of the other or complex fracture of both bones

  
  
• 
  

  The function of the arm is to position the hand in space. The forearm not only contributes to flexion and extension of the arm but is also responsible for all rotational positioning of the hand.

  
  
• 
  

  Forearm rotation occurs as the radius to which the wrist and the hand are attached rotates around the immobile ulna. Proximally, rotation occurs at the proximal radioulnar joint; distally, at the distal radioulnar joint. In the supine position the radius and ulna lie almost parallel, but in pronation the radius crosses the long axis of the ulna (Fig 3.7-1a).

  
  
• 
  

  Rotation is dependent on the shape of the forearm bones as well as on the integrity of the proximal and distal radioulnar joints. The forearm is in effect a complex joint.

  
  
• 
  

  To maintain full rotation, forearm shaft fractures require accurate anatomical reduction.

  
  
• 
  

  Disturbance in fracture healing, axial or rotational deformities, or healing with excessive callus will result in a loss of rotation; thus affecting hand function.

  
  
• 
  

  Isolated, completely undisplaced fractures of one bone may be treated conservatively. All other forearm fractures in adults require fixation.

  
  
• 
  

  Isolated displaced fractures of the radius are always associated with a dislocation of the distal radioulnar joint and of the ulna with a radial head dislocation. Accurate reduction and fixation of the bone will usually result in reduction of the dislocation, although this must be confirmed with x-ray.

  
  
• 
  

  The radius is more difficult to treat than the ulna because of its curved shape, its irregular cross-section with thick cortices, and its permanent torsional loading.

  
  
• 
  

  Preoperative planning is mandatory.

  
  
• 
  

  When planning fixation, consider not only the bony fracture pattern but also the state of the soft tissues which have been damaged at time of injury.

Müller AO/OTA Classification—forearm shaft fractures

22 radius/ulna, diaphyseal

3.7.1 Radius and ulna fracture (22-A3): stabilization with LC-DCP 3.5

Surgical management

• 
  

  Fixation with LC-DCP 3.5

Alternative implants

• 
  

  DCP 3.5

  
  
• 
  

  LCP 3.5

1 Introduction

• 
  

  Simple oblique fractures may be fixed with a lag screw reinforced by a protection plate, while transverse ones require the plate to be used as a compression plate. Severe multifragmentary fractures usually require the plate to be used as a bridging plate.

  
  
• 
  

  With poor-quality bone, the use of an LCP and locking screws should be considered. This is not normally necessary in young adults.

2 Preoperative preparation

Operating room personnel (ORP) need to know and confirm:

• 
  

  Side and site of fracture

  
  
• 
  

  Type of operation planned

  
  
• 
  

  Ensure that operative site has been marked by the surgeon

  
  
• 
  

  Condition of the soft tissues (fracture open or closed/compartment syndrome)

  
  
• 
  

  Implant to be used

  
  
• 
  

  Patient positioning

  
  
• 
  

  Details of the patient (including a signed consent form and appropriate antibiotic and thromboprophylaxis)

  
  
• 
  

  Comorbidities, including allergies

Instruments required:

• 
  

  LC-DCP 3.5 small fragment set, ie, instruments, screws, and plates

  
  
• 
  

  Bending tools

  
  
• 
  

  General orthopaedic instruments

  
  
• 
  

  Compatible air or battery drill with attachments

Equipment:

• 
  

  Operating table with radiolucent arm board attachment

  
  
• 
  

  Positioning accessories to assist with supine position of the patient

  
  
• 
  

  Image intensifier

  
  
• 
  

  X-ray protection devices for personnel and patient

  
  
• 
  

  Tourniquet (optional)