Forearm trauma

48 Forearm trauma





Questions



image What is a Galaezzi fracture?

image What is a Colles’ fracture and how is it managed?

image How is a scaphoid fracture managed?



Fractures


If there is one obvious fracture of the forearm, the arm should be examined to see if there is another fracture or a dislocation; radiographs of the distal and proximal joint must be taken.



Fractures around the elbow



Supracondylar fractures


Supracondylar fractures occur chiefly during childhood but may occur in adults (Ch. 51).



Olecranon


The olecranon is easily fractured as the result of a FOOSH or a direct blow. The fracture is commonly displaced and requires ORIF with K-wire fixation.



Radial head


The radial head easily fractures. Undisplaced fractures can be treated with a support bandage and early immobilization. Displaced fractures may need ORIF.



Condylar fractures


Medial epicondylar fractures are often missed, especially in young children. They are often intra-articular and, consequently, need careful examination followed by ORIF with K-wires. Lateral condylar fractures most commonly occur in preschool children; if significantly displaced, ORIF is required. Condylar fractures can cause growth arrest, mal-union, stiffness and ulnar nerve palsy.



Mid-shaft fractures


Fractures involving both the radius and ulnar are common and are often open; complications are frequent (mal-union, compartment syndrome, cross-union). A Galeazzi fracture– dislocation is a radial fracture with dislocation of the distal radioulnar joint (Fig. 3.48.1). Mal-union is common, so ORIF is indicated. The Monteggia fracture–dislocation is the mirror image of this and is frequently missed in children. These two fractures should not be confused with a simple Colles’ fracture, and they illustrate the need for a full set of radiographs. They are often unstable, and so ORIF is the treatment of choice with plates and/or intramedullary nail.


image

Fig. 3.48.1 Mid-shaft fractures. (A) The Galeazzi fracture–dislocation; (B) a Monteggia fracture is a ‘mirror image’.

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Forearm trauma

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