Both Bone # of Forearm

8/6/2019 Both Bone # of Forearm

1/40

PRESENTED BY: INTERNS 5TH

BATCHDR. APARNA MISHRA

DR. ADITI MISHRA

DR. SASHMI MANANDHAR

DEPARTMENT OF ORTHOPAEDICS

DH - KUTH


2/40

CASES PRESENTED AS..


3/40

CASE 1 . . .HISTORY

9 YRS/ M, SINDHULI ON 30/08/10

FALL INJURY ON THE RIGHT FOREARM 6 HRS BACK PAIN

UNABLE TO MOVE RT LIMB

KHURKOT HOSPITAL > XRAY & REFERRED

NO H/O OTHER INJURIES


4/40

CASE 1 . . .GPE GC NORMAL

VITALS STABLEL/E SWELLING ABSENT

DEFORMITY PRESENT

NO WOUNDS TENDERNESS PRESENT

ROM PAINFUL

DNVS INTACT


5/40

CASE 1 . . . .INV

XRAY RT FOREARM: AP& LAT


6/40

CASE 1 . . . .MANAGEMENT

SPLINT

ANALGESICS CR &LAC IN IVA


7/40

CASE 2 . . .HISTORY

9 YRS/M , BARABISE,

30/08/10 FALL INJURY ON LEFT

FOREARM 4 HRS BACK

PAIN , SWELLING

INABILITY TO MOVEHIS FOREARM

OPEN WOUND

NO H/O OTHER INJURY


8/40

CASE 2 . . . .

GPE GC NORMAL VITALS STABLE

L/E SWELLING DEFORMITY WOUND 2 *1CM , VOLAR ULNAR ASPECT LT FOREARM TENDERNESS ROM PAINFUL

DNVS INTACTROM PAINFUL


9/40

CASE 2 . . . .INV

HB 13.1 gm/dl

BT 2 min CT 10 min

XRAY LT FOREARM AP&LAT


10/40

CASE 2 . . . .MANAGEMENT IRRIGATION &

DEBRIDEMMENT

SPLINT

ANALGESICS

ANTIBIOTICS

CR & RUSH PINFIXATION RADIUS #

OR & RUSH PINFIXATION ULNA #

DRESSING


11/40

CASE 3 . . . .HISTORY

12 YRS / M , KAVRE ,

27/08/10 FALL INJURY ON RT

FOREARM


12/40

CASE 3 . . . .GPE GC NORMAL

VITALS STABLEL/E SWELLING DEFORMITY

WOUND 1 *1CM , VOLAR ULNAR ASPECT LT FOREARM TENDERNESS ROM PAINFUL DNVS INTACTROM PAINFUL


13/40

CASE 3 . . . .INV

HB 12.1 gm/dl

BLOOD GRP - A + XRAY RT FOREARM AP

& LAT


14/40

CASE 3 . . . .MANAGEMENT

SPLINT

ANTIBIOTICS ANALGESICS

CR ATTEMPTED


15/40

BACKGROUND


16/40

INTRODUCTION

# of both radius and

ulna


17/40

AO CLASSIFICATION - A

y A1 Simple fracture, of the ulna, radiusintact

y .1 obliquey .2 transversey .3 with dislocation of the radial head

(Monteggia)

y A2 Simple fracture, of the radius, ulnaintact

y .1 obliquey .2 transversey .3 with dislocation of the distal radio-

ulnar joint (Galeazzi)

y A3 Simple fracture of both bonesy .1 radius, proximal zoney .2 radius, middle zoney .3 radius, distal zone


18/40

AO CLASSIFICATION - By B1 Wedge fracture, of the ulna, radiusintacty .1 intact wedgey .2 fragmented wedgey .3 with dislocation of the radial head

(Monteggia)

y

B2 Wedge fracture, of the radius, ulnaintacty .1 intact wedgey .2 fragmented wedgey .3 with dislocation of the distal radio-

ulnar joint (Galeazzi)

y B3 Wedge fracture, of the one bone,simple or wedge fracture of the other

y .1 ulna wedge and simple fracture ofthe radius

y .2 radial wedge and simple fracture ofthe ulna

y .3 ulnar and radial wedges


19/40

AO CLASSIFICATION - C

y C1 Complex fracture, of the ulnay .1 bifocal, radius intacty .2 bifocal, radius fracturedy .3 irregular

y C2 Complex fracture, of the radiusy .1 bifocal, ulna intacty .2 bifocal, ulna fracturedy .3 irregular

y C3 Complex fracture, of bothbones

y .1 bifocaly .2 bifocal of the one, irregular of

the othery .3 irregular


20/40

# IN DISTAL REGION - Iy INCIDENCE:

y Most commony M:F:: 3:1y 6 12 yrs

y CLASSIFICATION:y

Physeal fractures (Salter Haris Iand II)y Distal radiusy Distal ulna

y Distal metaphyseal (radius orulna)y Torus (Convex elevation at the # site)

y Greensticky Complete fractures

y Galeazzi fracturedislocations(Radial shaft # + dislocation ofdistal radioulnar jt)y Dorsal displacedy Volar displaced


21/40

# IN DISTAL REGION - II

y MECHANISM OF INJURY:y Fall on outstretched hand

y EVALUATION:y Symptoms:

y Tenderness, Swellingy Silver fork or reverse apex

deformity

y XRAY:y Deformityy Rule out the injuries to

radioulnar joint andhumerus


22/40

# IN DISTAL REGION - IIy TREATMENT:

y Acceptibility criteria:y 50% apposition 25 deg angulationy 1 cm overlap

y Non displaced and torus: 4 wksy Sugar tong splint Short arm cast Munster cast

y Greenstick #:y

Reduction with completion of the # on the concave side + splintingy Displaced #

y Reduction before hematoma formation under anaesthesiay Immobilization in the most stable position

y Operative: Indicationy I/L supracondylar #y Open #y Compartment syndromey Carpal tunnel syndrome

y COMPLICATIONS:y VIC Cross union of radius and ulnay Tear of triangular fibrocartilage


23/40

# IN THE SHAFT - I

y INCIDENCE:

y Most common reason

for orthopaedic surgeryof the forearm

y CLASSIFICATION:

y

Nondisplaced #y Greenstick #

y Displaced #

y Plastic formation


24/40

# IN THE SHAFT - IIy MECHANISM OF INJURY:

y Fall on outstretched handy Plastic deformation (bowing) of radius and ulna


y Tender # sitey Aggravated on supination and pronationy Deformity depending on degree of displacement

y XRAY: AP and lateral

y Asociated injuries:y Supracondylar humerus #y Monteggia #y Galeazzi #


25/40

# IN THE SHAFT - IIIy TREATMENT:

y Non displaced: LRC for 4 6 wksy Greenstick:

y Correction of rotation and angulationy LAC with elbow in flexion

y Displaced:y Reduction and stabilization under anaesthesiay Operative indications:

y Open # Segmental # I/L upper extremity injury y Failure of reduction and stabilization

y Operative methods: fixation of both #y Plate and screws: Rotational stabilityy Intramedullary fixation: # must be reducibley External fixation: Soft tissue injury

y Plastic:y

< 6 yrs: reduction not necessaryy > 6 yrs: reduction with 3 point pressure + LAC for 6 wks

y COMPLICATIONS:y Refracture Compartment Syndromey Cross healing with a creation of radioulnar synostosisy Loss of rotation


26/40

MONTEGGIA # - Iy INTRODUCTION:

y # of ulna with dislocation ofradiocapitellar joint

y INCIDENCE:y Age: 7-10 yrs

y CLASSIFICATION: (Bado, accto disloc of radial head)y Type I: Ant, commonest

y Type II: Post, common inadultsy Type III: Lateraly Type IV: Type I + radial shaft

#


27/40

MONTEGGIA # - IIy MECHANISM OF INJURY:

y Type I: Direct blow on thepost aspect of the forearm,hyperpronation, fall on hyperextended elbow

y Type II: Elbow flexion

y Type III, IV: Unclear


y forearm rotation

y With or without palpable radial

head

y XRAY: AP and lateraly Normal: long axis of the radius

intersects the centre of thecapitellum


28/40

MONTEGGIA # - IIIy TREATMENT:

y Closed RX: Deformity of ulna reversed and radial headmanually reduced + Cast for 4 wks

y Open RX:y Removal of interposed tissue + reconstruction of annular ligamenty

ORIF of ulna and fixation of radial head to capitellumy Delayed Open RX:

y Open reduction of radiocapitellar joint and reconstruction ofannular ligament

y COMPLICATIONS:y Cubitus Valgusy Collateral ligament instabilityy Redislocation of radial heady Non union or malunion of ulnay PIN injury


29/40

BOTH BONE # OF FOREARM IN ADULTS

y Closed reduction and casting not unacceptabley RX of choice: ORIF with plate and screw fixation

y DCS for interfragmentary compression

y Bone grafting: Indications

y Comminution involving >1/3 diaphyseal cortex at # site

y Segmental bony defects

y Significant depression of radial articular surface


30/40

AND THE JOURNALS SAY


31/40

Journal of Pediatric Orthopaedics: May/June 200554 operations in 50 patients with both-bones fractures:fractures healed within 8 to 10 weeks, except for two delayedunions and one nonunion

Complication rate was 5% for closed treatment, 33% forORIF, and 42% for IM nailing.

More complications with operative techniques

ORIF had more major complications


32/40

Recent studiesy Prasarn et al reported on a treatment protocol for

repair of infected nonunions of diaphyseal forearm

fractures in 15 patientsy patients had at least 50 of supination/pronation and

30-130 of flexion/extension arc (except 3)

y average time to union was 13.2 weeks (range, 10-15

weeks).1


33/40

yJan 8 2010: Janos P ertl

y Teoh et al compared the differences in

radiographic and functional outcomes of unstableboth-bone diaphyseal forearm # after t/t witheither IM fixation or plate fixation with screws

y Osteomyelitis occur in the IM fixation group

y Ulnar never palsy occurred in the plate-fixationgroup

y Nonunion or malunion was not observed


34/40

Surgical treatment of unstable diaphyseal both-bone

forearm fractures in children with single fixation of

the radius

y 3 April 2000, journal of pediatrics orthopedics

y 50 children (5 to 14 years; mean age 11 years) with

unstable diaphyseal forearm #, closed reduction hasbeen unsuccessful

y ORIF of radius only

yAfter anatomical reduction and fixation of the radiusthe ulnar fracture had a better alignment


35/40

Acceptable Alignment of Forearm Fractures

in Children: Open Reduction Indications

yJournal of Pediatric Orthopaedics B: March 2010

y

Complex or unstable # / Not maintained in acceptablealignment- surgical intervention

y angulation is more critical for preservation of forearm

rotation


36/40

y 15 degrees angulation is recommended as maximumangulation for mid-shaft and distal-shaft fractures inchildren younger than 8 years

y 10 degrees is recommended as the maximumacceptable angulation for older children and proximalshaft fractures

y

fractures with complete displacement will remodelsatisfactorily


37/40

Hand dominance and gender in forearm fractures

in children

y Freih Odeh Abu Hassan november 2008

y181 children aged 215 years presenting withunilateral forearm fracture were examined over a6-year period


38/40

y . Forearm fractures:

a. more in boys 70.2%

b. more common on the left sidec. Isolated distal radius fracture is more common

63.3%

d. Mean age for boys : 8.97

Mean age for Girls: 5.98


39/40

REFERENCEy Rockwood and Wilkins Fracture in Children

y Brinker Review of Orthopaedic Trauma


40/40

THANKYOU

Date post:	07-Apr-2018
Category:	Documents
Upload:	sashmi-sareen-manandhar
View:	222 times
Download:	0 times

Both Bone # of Forearm

Documents