Forearm Fractures

Radial Head Fracture

Radial Neck Fracture

Monteggia Fracture

Examination: localised tenderness over fracture site; incomplete elbow extension; pain on pronation / supinationManagement: sling and mobilise; OT if >1/3 articular surface involved / >30° angulation / >3mm depression / mechanical block / comminutedComplications: neurovascular complications uncommon

MOI: FOOSH; most common fracture of elbow; often associated injury (eg. Capitellum /olecranum / coronoid fracture, MCL injury, medial epicondyle fracture)Classification: I Displaced <2mm; no mechanical block II Displaced <2mm; >30% radial head involvement; maybe mechanical block III Comminuted IV + dislocation Others: hairline, marginal, segmental

Galeazzi Fracture

Intra-articular so require careful reductionClassification: I Displaced <2mm; treat conservatively II Displaced but ulnohumeral joint stable; needs OT III Displaced and unstable

Essex – Lopresti Fracture

Fractured radial head and Dislocation of distal radioulnar joint

MOI: FOOSHExamination: tenderness more distal; less painManagement: sling if no angulation (up to 30° allowed in children); manipulate if >20° angulation with traction, supination and pronation; OT if gross displacement / epiphyseal injury

Olecranon Fracture

Midshaft Fractures OT if: displaced, unstable, >10° angulation, or subluxation of proximal / distal radioulnar joint

Nightstick Fracture

Midshaft ulnar due to direct blowNeeds POP 6-8/52ORIF if: >50% displacement or >10° angulation or proximal ⅓

Fracture proximal ⅓ ulna with dislocated radial head (anteriorly in 60%)MOI: FOOSHComplications: interosseous and radial nerve injury; malunion and nonunion; unstable radial headMng: ORIF; can be managed closed in children

Reverse Monteggia; fracture midshaft or distal ⅓ radius with dislocated distal radioulnar joint; 3x more common than MonteggiaMOI: FOOSHXR: radial styloid should project 8-18mm distal to radioulnar joint; distal radius should articulate with at least ½ lunate; ulna and radius should be meet to form smooth jt surface Shortening of radius by 5mm; fracture ulnar styloid process (60%); widened distal radioulnar joint space by 2mm; subluxation of distal radioulnar jointComplications: malunion, nonunion, instability of DRUJ; damage to ulnar nerve and anterior interosseous branch of median nerveMng: ORIF

Hume FractureFractured olecranon with Radial head dislocated anteriorly

Colles Fracture

Transverse fracture distal radius 4cm proximal to wrist, with dorsal + radial angulation and displacement; possible proximal displacement and dorsal comminution; associated ulnar styloid # in 60% (always give it a pull if this is present as suggests serious disruption of inferior radio-ulnar joint); may be intra-articular extensionGive it a pull if: >10° dorsal angulation; >5° radial angulation; 2-5mm radial shortening; intra-articular step >2mm traction, extension, 10° flexion, full ulnar deviation POP 5-6/52OT if: >20° dorsal angulation; >5mm radial shortening; >1cm displacement; >50% dorsal comminution; palmar metaphseal comminution; intra-articular disruption; associated ulna/carpal fracture; severe osteoporosis; associated NVI or tendon injury; shearing fracture; open; impaired contralateral wrist; splitting of radial fragment; failed conservative treatment

Buckle fracture of distal radiusUndisplacedMechanically stablePOP 2-4/52

Torus Fracture

Colles Fracture (cntd)

Complications: shoulder + wrist stiffness (30%); median nerve compression (5-10%; palmar paraesthesia; if still present after pull, OT); malunion (5%); delayed union (1-2%); nonunion (0.2%); complex regional pain syndrome (1-4%); EPL rupture (3%; due interrupted vascular supply; occurs 4- 8/52 later); compartment syndrome (0.25%; usually anterior); triangular fibrocartilage complex injury; radioulnar and radiocarpal instability; arthritis

Smith’s Fracture

Fracture distal radius 1-2.5cm proximal to wrist with volar displacement and angulation (Reverse Colle’s); garden spade deformityMOI: fall on back of handMng: traction in supination and wrist extension; above elbow POP 6/52; may need ORIF especially if adult

Barton’s Fracture

Dorsal / volar rim fracture of distal radius extending intraarticularily; dorsal rim more common; carpals usually subluxed or dislocated with fragment in same direction; unstable as ligamentous injury associated; ORIF needed; can do closed reduction if <50% joint surface involved and no carpal subluxation

Henderson (Chauffeur’s)

Fracture

Radial styloid fracture from kickback; POP; most ligaments attach onto radial styloid so can be carpal instability; ORIF if displaced / POP fails; may be associated with lunate dislocation, scapholunate dissociation, trans-styloid perilunar dislocation, dorsal Barton’s #