Tarronas, Franklin Marc E.

Orthpedics
Lec group 10 August 11, 2013


I. Salient Features
12 year old boy with forearm fracture of the right forearm
o Open wound on fracture site; patient seen 2 hours post trauma
o Sharp pain resulting to limitation of ROM on elbow and wrist joints
o Sensory function intact on affected limb
o Finger function of all digits intact
Patient is right handed
Know asthmatic, last attack 2012
Other organ systems essential normal on physical exam

II. Assessment
Fracture, Closed, Complete, displaced, transverse, D3 Radius, Right
Fracture, Open I, Complete, displaced, transverse, D3 Ulna, Right
(similar but not the patients Xray)

III. Plan

A. Wound Debridement

Initial management involves immediate wound debridement to prevent further complications
and infections of open fractures. Open fracture management represents an orthopedic
emergency. Injuries within the first 6 hours have been recommended to be immediately
managed to minimize long term sequelae.




Tarronas, Franklin Marc E. Orthpedics
Lec group 10 August 11, 2013

B. Open Reduction with internal fixation by intramedullary nailing

The goal for our patient if fracture stabilization to prevent further injury and complications and
allow the return to previous function especially since the patients dominant hand is affected.
Intramedullary nailing was first and widely used in 1959 by Sage. When intramedullary devices
are used in persons with fracture of both bones, fixation of the radius must be stable enough to
prevent collapse of the radial bow; otherwise, elongation of the radius and distraction of the
ulnar fracture can occur, resulting in nonunion in either or both bones. This may be done under
general anesthesia with guidance of C-arm intraoperatively

C. Antibiotic Treatment
Antibiotic treatment recommended is Cefazolin or an antibiotic with similar gram positive
coverage given an open type I fracture.

IV. Complications
Malunion
Infection
Compartment Syndrome
Rehab may be warranted and recommended to the patient to return the function of
his dominant hand

V. Prevention and Public Health Issues
Educate the public on sports related safety

Advocate and inform schools and local clinics on initial management of fractures

Prices of implants and screws are still a big financial burden for most patients