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Injuries of the forearm. By : Dr.Sanjeev. Monteggia Fracture Dislocation. Fracture upper third of ulna with dislocation head of the radius . Mechanism: More common in children fall on outstretched hands either in hyperpronation or in hyperextension .

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monteggia fracture dislocation
Monteggia Fracture Dislocation.
  • Fracture upper third of ulna with dislocation head of the radius .

Mechanism:

  • More common in children
  • fall on outstretched hands either in hyperpronation or in hyperextension .
  • C / F : - Pain , Swelling, deformity, severe loss of forearm movement.
  • Radiology : AP, lateral.
slide3
.
  • Fig : -
classification
Classification
  • Type 1 (60%) : anterior dislocation of head of the radius with fracture ulna at upper third and with anterior angulation.
  • Type 2 (5%) : posterior dislocation head of the radius and fracture proximal ulna with posterior angulation.
  • Type 3 (20%) : lateral dislocation head of the radius and fracture proximal ulna with lateral angulation.
  • Type 4 (15%) : fracture radius and ulna in their upper one – third and anterior dislocation of head of the radius with anterior angulation.
slide5
Cont..
  • Fig : - Type 1:
slide6
Cont..
  • Fig : - Type 2 :
slide7
Cont..
  • Fig : - Type 3
slide8
Cont..
  • Fig : Type - 4
clinical symptoms
Clinical symptoms :

Type 1 , Type 2 , Type 3 and Type 4 :

  • Marked pain and tenderness about the elbow
  • No flexion , extension , pronation , and supination.
  • Paralysis of the interosseous nerve may occur.
clinical signs
Clinical signs

Type 1 : - HOR felt anteriorly

- Anterior angulation

Type 2 : - HOR posterior

- Posterior angulation of ulna

- Shortening of forearm

Type 3 : - HOR is lateral

- Lateral angulation

Type 4 : - HOR is anterior

- Deformity is at the fracture level

(HOR = HEAD OF RADIUS)

treatment in children
TREATMENT : In children
  • Type 1 :
  • Closed reduction (if fails)
  • OR of fracture ulna + CR of HOR (if fails)
  • OR of fracture ulna with OR of head of the radius

Type 2 :

  • CR (closed reduction )
  • OR (open reduction

Type 3 : - CR

slide12
CONT..

Type 4 :

  • CR (if fails )
  • OR rigid IF with plate and screws

IN ADULTS : (type 1, 2, 3 and 4)

  • OR + IF of fracture ulna with plate and screws
  • CR of HOR (if fails)
  • OR ,HOR +IF fracture ulna
  • If fracture more than 6 weeks excision HOR is done.
complications
Complications
  • Posterior interosseous nerve palsy .
  • Radial head instability
  • Nonunion of fracture ulna.
  • Malunion of fracture ulna.
  • Myositis ossificans
galeazzi fracture dislocation
Galeazzi fracture dislocation
  • Fracture of the radial shaft at the junction of middle and distal third with associated subluxation or dislocation of the distal radioulnar joint.
  • Reverse Monteggia
  • Also known as fracture of necessity (which requiresORIF)
forces causing loss of reduction and difficulty in reduction
Forces causing loss of reduction and difficulty in reduction :
  • Insertion of pronator quadratus pulls the distal fragment in proximal and volar direction
  • Brachioradialis uses the distal radioulnar joint as a pivot and causes shortening
mechanism of injury
Mechanism of injury : -

.

- Direct blow on the dorsolateral side of the forearm

- Fall on an outstretched hand with marked pronation of the forearm .

clinical features
Clinical features :
  • Pain,
  • swelling,
  • Deformity of the lower end of the forearm
  • Pronation and supination are severely restricted.
  • Neurovascular injury is rare.
radiological
AP view :

Fracture radius , transverse or short oblique

Distal radioulnar joint is dislocated

Radius appears short

Lateral view :

Radius is angulated dorsally

Head of the ulna is prominent dorsally.

Radiological :
slide24
CONT..

FIG : AP - VIEW

slide25
Cont…

FIG : - LATERAL VIEW

treatment
Treatment
  • ORIF(Plate and screw fixation).
  • Distal radio – ulnar joint stability..?
    • Yes plaster ,
    • No K wire fixation.
complications1
Complications
  • Malunion loss of supination/ pronation.

(osteotomy).

  • Nonunion bone grafting.
  • Compartment syndrome.
  • Angulation of the fracture and subluxation of the distal radioulnar joint.
barton s fracture
Barton’s fracture
  • Fracture line extends from the distal articular surface of the radius.
  • Dislocation or subluxation usually associated.
  • Most are unstable.
  • ORIF.
slide31
Cont..
  • Fig : -
radial styloid fracture
Radial styloid fracture
  • Also known as chauffeur’s fracture; Hutchinson fracture.
  • Posterior marginal fracture of the radius
  • Avulsion fracture of the radiocarpal ligament
  • Seen in motorcycle accidients , and fall from heights
slide33
Cont ..
  • Fig : Radial styloid fracture
clinical features1
Clinical features
  • Pain
  • Swelling
  • Tenderness over the radial styloid process
  • Movement of the wrist, especially radial deviation , is painful

Radiology :

  • AP – shows transverse fracture
treatment1
Treatment
  • Closed reduction and above elbow plaster cast

Unstable fractures :

  • percutaneous with K - wire
slide36
Cont..
  • Fig : long armed cast