1 / 29

Injuries of the forearm

Injuries of the forearm. By : Dr . sanjeev. Normal wrist joint. Fig : - . Normal wrist joint. Fig : - . Colle’s fracture. describe by : - Abraham colle`s - 1814. Definition : - it is not just fracture lower end of radius but a fracture dislocation of the inferior radioulnar joint .

bonifacy
Download Presentation

Injuries of the forearm

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Injuries of the forearm By : Dr . sanjeev

  2. Normal wrist joint • Fig : -

  3. Normal wrist joint • Fig : -

  4. Colle’s fracture. describe by : - Abraham colle`s - 1814. Definition : - it is not just fracture lower end of radius but a fracture dislocation of the inferior radioulnar joint . Occurs about 2.5 cm above the carpal extremity of the radius . Commonest age group- Elderly.( 60 yrs) Women> Men. MOA – fall in outstretched hand. Force required to cause this fracture is 192 kg in women and 282 kg in men.

  5. Colle’s fracture • Fig : -

  6. Colle’s fracture • Fig : -

  7. AP View • Fig : - colle`s fracture

  8. Clinical features.- • Swelling. • Pain. • Dinner fork defomity, it is not found in all cases but seen only if there is a dorsal tilt or rotation of the distal fragment Examination- Distal neurovascular status. External injuries.

  9. Dinner fork defomity • Fig :

  10. dorsal displacement of the distal fracture fragments.

  11. Styloid process test : • Normally , the radial styloid proces is lower by 1.3 cm when compaired to the ulnar styloid process. • In colle`s both radial and ulnar styloid processes are at the same level and are found in all displacements of colle`s fracture. • This is more reliable sign than dinner fork deformity

  12. Distance between radial and styloid processes • Fig :

  13. Colle’s fracture • Fig : -

  14. Fracture line Distal ulnar fracture Frykmann`s classification : Absent present 1 1 .. Extra - articular 2 2. Intra – articular (involving RC joint only ) 3 4 6 3 . Intra – articular (involving distal RU joint only ) 5 8 7 4 . Intra – articular (both RC + inferior RU joints ) RC = radiocarpal RU = radioulnar

  15. Frykmann`s classification • Fig :

  16. Radiograpy : X – ray of the wrist : - • AP and lateral views and lower end of the radius Displacement in a colle`s fracture : • Dorsal displacement • Dorsal rotation • Lateral displacement • Lateral rotation • Impaction • supination

  17. Treatment : • Conservative methods • Operative methods CONSERVATIVE METHODS : - closed reduction under general anaesthesia (GA),or local anaesthesia (LA) - If the level of the styloid processes are restored back to normal , it indicates that the reduction has been achieved satisfactorily. - limb is immobilised by colle`s cast and a check radiograph is taken - Removed after 6 – 8 weeks - physiotherapy

  18. 6 immobilisation method : • Below elbow cast (10 – 20 degree palmar flexon , 15 – 20 degree ulnar deviation ) COLLE`S CAST • ABOVE ELBOW CAST IN SUPINATION • ABOVE ELBOW CAST IN PRONATION . ABOVE ELBOW CAST IN MID- PRONATION . COTTON LODER`S POSITION( WRIST FULLY FLEXED) . EXTERNAL FIXATORS

  19. Colle`s cast It is a below elbow cast in supination and ideally it has to meet the following 4 criteria :- • Firm fit at the dorsum • Firm fit at the volar fracture apex • Just snuggly fitting at the forearm • Metacarpophalangeal joints should be free to move

  20. Colle`s cast

  21. Acceptable limits of colle`s fracture: • A dorsal tilt of less than 10 degrees • A radial shorteing of less than 5 mm. OPERATIVE METHODS : INDICATION : • Impaction • Median nerve intrapment

  22. Cont.. • Fig : -

  23. Surgical methods : 1 . Closed reduction and percutaneous pinning with k – wires 2 . Open reduction and plate fixation.

  24. Early complication : Unstable reduction Medial or ulnar nerve stretched Post reduction swelling Compartmental syndrome Anaesthesia problem Injury to proximal segment of the bone during reduction Late complication : Malunion Rupture of extensor pollicis tendon Frozen shoulder Carpel tunnel syndrome Nonunion Sudeck`s osteodystrophy Complication

  25. COLLE`S FRACTURE - Why is it called fracture of 6…? • Common at 60 years • Force required to cause colle`s fracture are multiples of 6 • 6 classical displacements • 6 method of fracture immobilisation • 6 important early and late complications • 60 per cent cases have fracture ulnar styloid

  26. Smith’s Fracture. • Reverse of colle’s fracture. • Wrist fracture in which the distal end of the radius is displaced forwards. Mechanism of injury : • Fall on the back of the dorsum of the hand • Fall on the forearm in supination • Direct blow to the flexed hand

  27. Colle`s and smith`s fracture • Fig : -

  28. Clinical features : - • Pain • Swelling • Deformity • Loss of wrist function • Deformity is opposite to that of colle`s fracture and is called the garden shaped deformity. Radiography : - • AP view of the wrist

  29. Complication : • Complication of colle`s Treatment : - • Closed reduction and immobilisation in a long arm cast with forearm in supination and wrist in extension. Unstable fractures : - • Fixation with k – wire or open reduction and plate fixation.

More Related