Forearm
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Fracture around forearm
Dr. Ashish Gohiya Asst. Professor Dept of Orthopaedics Gandhi Medical College Bhopal Dr. Ashish Gohiya
Anatomy
Dr. Ashish Gohiya
Proximal Third Frx above insertion of pronator teres. • proximal fragment of radius is supinated & flexed because of unopposed action of biceps brachii & supinator, and • the distal fragment is pronated by the action of the pronator teres & pronator quadratus muscles. • to obtain alignment of the fracture, the distal fragment should be supinated; Dr. Ashish Gohiya
Middle Third Fractures below pronator teres
• proximal fragment is held in neutral rotation, as • • •
action of supinator is countered by the pronator teres. proximal fragment is drawn into flexion by action of biceps. distal fragment is pronated & drawn toward ulna by pronator quadratus. to achieve anatomic reduction, distal fragment is brought into neutral rotation Dr. Ashish Gohiya
Distal Third Fractures below pronator teres
• •
distal fragment of the pulled radius is pronated & pulled inward by pronator quadratus. overriding & shortening are caused by obliquity of frx & pull of muscles.
Dr. Ashish Gohiya
Treatment • Non operative – Slab – Cast
• Operative – ORIF • Plating • Nailing
– Closed nailing
Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Pediatric Both Bone Forearm Fractures • frx may be greenstick or complete in both the radius and ulna. • mechanism: - indirect injury during fall on an outstretched hand; - direct violence occassionally is cause of both bone forearm.
Dr. Ashish Gohiya
Paediatric frxs • in pts < 6 yrs of age: – upto 15 deg of angulation is acceptable. – 5 deg of rotation may also be acceptable;
• between ages of 6-10 yrs – less than 10 deg of angulation should remodel especially if frx is close to distal epiphysis; – acceptable angulation is less than 15 deg.
• pts > 12 yrs of age – no angulatory or rotational deformity is considered acceptable. – more aggressive treatment is required, including open reduction and compression plating . Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Monteggia Fracture Dislocation • Fracture of the proximal ulna with dislocation of proximal end of radius.
Dr. Ashish Gohiya
Treatment Acute Frx • Closed reduction of radius head • Open reduction and internal fixation of ulna – Plate – Nail
Unreduced head • Open reduction of radius head – Repair of lig. – Reconstruction of lig.
Late presentation • Radial head excision In childrern close reduction & cast with elbow >90 flex. Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Galeazzi Fracture Dislocation • Fracture of necessity • Fracture of distal third radius with dislocation of distal radioulnar joint (DRUJ)
Dr. Ashish Gohiya
Treatment • ORIF – Plate (DCP)
• DRUJ may require “K” wire fixation.
Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Dr. Ashish Gohiya Asst. Professor Dept of Orthopaedics Gandhi Medical College Bhopal Dr. Ashish Gohiya
Anatomy
Dr. Ashish Gohiya
Proximal Third Frx above insertion of pronator teres. • proximal fragment of radius is supinated & flexed because of unopposed action of biceps brachii & supinator, and • the distal fragment is pronated by the action of the pronator teres & pronator quadratus muscles. • to obtain alignment of the fracture, the distal fragment should be supinated; Dr. Ashish Gohiya
Middle Third Fractures below pronator teres
• proximal fragment is held in neutral rotation, as • • •
action of supinator is countered by the pronator teres. proximal fragment is drawn into flexion by action of biceps. distal fragment is pronated & drawn toward ulna by pronator quadratus. to achieve anatomic reduction, distal fragment is brought into neutral rotation Dr. Ashish Gohiya
Distal Third Fractures below pronator teres
• •
distal fragment of the pulled radius is pronated & pulled inward by pronator quadratus. overriding & shortening are caused by obliquity of frx & pull of muscles.
Dr. Ashish Gohiya
Treatment • Non operative – Slab – Cast
• Operative – ORIF • Plating • Nailing
– Closed nailing
Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Pediatric Both Bone Forearm Fractures • frx may be greenstick or complete in both the radius and ulna. • mechanism: - indirect injury during fall on an outstretched hand; - direct violence occassionally is cause of both bone forearm.
Dr. Ashish Gohiya
Paediatric frxs • in pts < 6 yrs of age: – upto 15 deg of angulation is acceptable. – 5 deg of rotation may also be acceptable;
• between ages of 6-10 yrs – less than 10 deg of angulation should remodel especially if frx is close to distal epiphysis; – acceptable angulation is less than 15 deg.
• pts > 12 yrs of age – no angulatory or rotational deformity is considered acceptable. – more aggressive treatment is required, including open reduction and compression plating . Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Monteggia Fracture Dislocation • Fracture of the proximal ulna with dislocation of proximal end of radius.
Dr. Ashish Gohiya
Treatment Acute Frx • Closed reduction of radius head • Open reduction and internal fixation of ulna – Plate – Nail
Unreduced head • Open reduction of radius head – Repair of lig. – Reconstruction of lig.
Late presentation • Radial head excision In childrern close reduction & cast with elbow >90 flex. Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
Galeazzi Fracture Dislocation • Fracture of necessity • Fracture of distal third radius with dislocation of distal radioulnar joint (DRUJ)
Dr. Ashish Gohiya
Treatment • ORIF – Plate (DCP)
• DRUJ may require “K” wire fixation.
Dr. Ashish Gohiya
Treatment
Dr. Ashish Gohiya
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