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 .
C / F : - Pain , Swelling, deformity,
severe loss of forearm movement.
Radiology : AP, lateral.

.
Fig : -

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.

Cont..
Fig : - Type 1:

Cont..
Fig : - Type 2 :

Cont..
Fig : - Type 3

Cont..
Fig : Type - 4

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
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
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

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

Posterior interosseous nerve palsy .

Radial head instability
Nonunion of fracture ulna.
Malunion of fracture ulna.
Myositis ossificans

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 requires ORIF)

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 : .
- Direct blow on the dorsolateral side
of the forearm
- Fall on an outstretched hand with
marked pronation of the forearm .

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.

CONT..
FIG : AP - VIEW

Cont
FIG : - LATERAL VIEW

Treatment
ORIF(Plate and screw fixation).
Distal radio ulnar joint stability..?
Yes plaster ,
No K wire fixation.

Complications
Malunion loss of supination/
pronation.
(osteotomy).
Nonunion bone grafting.
Compartment syndrome.
Angulation of the fracture and
subluxation of the distal radioulnar
joint.

Bartons fracture
Fracture line extends from the distal
articular surface of the radius.
Dislocation or subluxation usually
associated.
Most are unstable.
ORIF.

Cont..
Fig : -

Radial styloid fracture

Also known as chauffeurs fracture;
Hutchinson fracture.
Posterior marginal fracture of the
radius
Avulsion fracture of the radiocarpal
ligament
Seen in motorcycle accidients , and
fall from heights

Cont ..
Fig : Radial styloid fracture

Clinical features
Pain
Swelling
Tenderness over the radial styloid
process
Movement of the wrist, especially
radial deviation , is painful
Radiology :
AP shows transverse fracture

Treatment
Closed reduction and above elbow
plaster cast
Unstable fractures :
percutaneous with K - wire

Cont..
Fig : long armed cast