Injuries Around Forearm Final

Injuries around forearm Dr Abhishek Pathak Assistant Professor Deptt. of Orthopaedics Gandhi Medical College Bhopal

Introduction • Two bones – Radius & Ulna

Joined together by interosseous membrane

Forms a unit

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Joints

2. Proximal and distal radioulnar joint 3. Radiohumeral joint – b/w radius & capitulum 4. Ulnohumeral joint – b/w ulna & trochlea 5. Wrist joint – Radio and ulno carpal joint

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Introduction •

Ligaments that hold bone together

2.

Proximal & distal condensation of interosseous membrane

3.

TFCC

4.

Various other ligament that hold radius and ulna with humerus & wrist joint.

These are very important to maintain the functional integrity of forearm.

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Movements •

Elbow joint:-

2.

Flexion- a) biceps b) brachialis c) brachioradialis

5.

Extension – triceps & anconeous

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Movements • Supination Biceps and supinator • Pronation Pronator teres and quadratus

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Olecranon Fracture • M/c indirect force • Leading to transverse # • Almost always treated by operative method TRICEPS

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• Treated by ORIF with Tension Band Wiring • Principle Converts distraction forces into Compression Forces

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Pulled elbow (nursemaid elbow) • Young child (2 years) with acute elbow pain and complete loss of movement after being pulled from hand • Forearm is pronated

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• Treated conservatively by gentle supination and reduction of radial head. • Dramatic response.

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MONTEGGIA FRACTURE-DISLOCATION • FRACTURES OF PROXIMAL THIRD OF ULNA WITH DISLOCATION OF RADIAL HEAD • Mode of injury- fall on outstretched hand. • Immediate splintage for pain relief provided by A/E slab in supination.

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General rule of immobilisation

2.

Upper third- supination.

3.

Middle third- midprone

4.

Lower third- pronation

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Bado’s classification

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• Conservative treatment only in children • In adults treated by ORIF with Dynamic compression plate or intramedullary nail with close reduction of radial head.

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Green stick fracture

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Night stick fracture

2.

Occurs in children

2.

Isolated ulna fracture

3.

Due to thick periosteum.

3.

Cane or stick injury

4.

Unicortical breech

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Galeazzi fracture-dislocation • Fracture of distal third of radius with dislocation of distal radioulnar joint . • The combination of fracture of the distal third of the shaft of the radius and dislocation of the distal radioulnar joint was called ‘‘the fracture of necessity’’ by Campbell.

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Treatment • Operative • ORIF with DCP & reduction of DRUJ • Rigid anatomical fixation of the radial shaft fracture generally reduces the distal radioulnar joint dislocation. If this joint is still unstable, it should be temporarily transfixed with a single Kirschner wire with the forearm in supination

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Fracture both bone fore arm • m/c bone to fracture in children. • Mode of injury:• Direct assault • Fall on out stretched hand • Conservative treatment only in children • As both bones are fractured so difficult to maintain reduction so ORIF is treatment of choice, intramedullary nail can also be done

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Immidiate immobilization in A/E plaster slab

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Always check distal neurovascular status

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