L1 Orthopedic D. Wahby Ghalib
Forearm Fractures
The radius rotates around the ulna
pronation 90°
supination 90°
Both Bones
Fall on the hand at different levels
Direct trauma same level
Rx
< 14 yr.
CR + above elbow cast
If irreducible or unstable
ORIF
Cast
Upper 1/3 : in supination
Middle 1/3 : neutral
Lower 1/3 : pronation
> 14 yr.
ORIF because unstable
Cx.
Early : compartment syndrome
Late : malunion
synostosis
o affect pronation-supination
# of the ulna alone
uncommon
Night - stick #
May be missed
Nonunion is common
Monteggia fracture dislocation
# of proximal 1/3 ulna + dislocation of radial head
Types (Bado)
I : Anterior : commonest
II : Posterior
III : Lateral
IV : With # of proximal radius
Mechanism
Fall on outstretched hand
Direct
Rx
Child
o CR + cast
Adult
o ORIF of ulnar #
o CR of radial head
o immobilization in supination
Galeazzi fracture dislocation
o # of distal 1/3 radius + dislocation or subluxation of DRUJ
common than Monteggia
Mechanism
Fall on hand
Unstable DRUJ
o Piano key sign
o Rotatable wrist
Rx
Child
o CR + cast
Adult
o ORIF of radius # + CR of
DRUJ
o immobilize in supination
Mubark A. Wilkins