Forearm Fractures

Abdullah Matar
 Colles Fracture
It is a transverse fracture of the radius just above the
wrist, with dorsal displacement of the distal fragment.
It is the most common of all fractures in older people ,
the high incidence being related to the onset of
postmenopausal osteoporosis
With undisplaced fractures, there may be pain and
swelling but little or no deformity. Displaced fractures
produce a distinctive dorsal tilt just above the wrist
the so-called dinner-fork deformity.
X-Ray : the distal fragment is shifted and tilted both
dorsally and towards the radial side; in some cases the
fracture is impacted, in others it may be severely
comminuted.
Dinner Fork Deformity
Dorsal angulation of the distal fracture fragment is present to a
variable degree , also there is usually impaction with resultant
shortening of the radius
Ulnar styloid fractureis present in up to 50%
of cases of colles fracture
Management of Colles Fracture
Undisplaced : dorsal splint is applied for 12 days
until the swelling has resolved, then the cast is
completed for 4 weeks .
Displaced : Must be Reduced under Local
Anesthesia , then disimpact the fragments with
traction , then distal fragement pushed into its place
by pressing on dorsum , then put wrist into moderate
flexion, ulnar deviation and pronation ( NOT
EXTREME , 20 degree is enough ) , then X-ray
recheck , If satisfactory do plaster slab .
The fracture usually unites in about 5 weeks and,
even in the absence of radiological proof of union, the
slab may then be discarded and exercises begun.
Management of Colles Fracture

Comminuted and unstable :

Options include : Percutenous K wire fixation ,
External Fixation added to wires ( for very unstable
and osteporotic # ) , Bone Grafts , Internal
Fixation
Smiths fracture
the distal fragment is displaced and tilted
anteriorly (which is why it is sometimes called
a reversed Colles). It is caused by a fall on
the back of the hand.
Management of Smiths Fracture

Reduction by traction and extension of the

wrist. The forearm can be immobilized in a
cast for 6 weeks. If the fracture is unstable
(and they usually are), percutaneous wires will
add support.
However, rigid fixation with a volar locking
plate allows earlier return of function.
Complications of Colles Fracture
Circulatory Impairment
Nerve injury : Median Nerve
Malunion : If marked Osteotomy
Associated radio-ulnar and carpal injuries
Tendon rupture : extensor pollicis longus
Joint stiffness
Complex regional pain syndrome : formerly called
Sudecks atrophy or reflex sympathetic dystrophy , Signs are Pain
( tender) , Vasomotor impairment , Swelling , osteoporosis on x
ray , and activity of bone scan .
Fracturesubluxation of the wrist
(Bartons fracture)
Bartons injury is an oblique fracture
which runs from the volar surface of
the distal end of the radius into the
wrist joints. The fragment is often
displaced anteriorly, carrying the
carpus with it as a fracturedislocation.
The significance of recognizing this
fracture is that it can be expected
to be unstable.
Management of Bartons Fracture
The fracture may be easily reduced, but it is
just as easily re-displaced. Internal fixation,
using a small anterior buttress plate, is
recommended.
Monteggia fracture dislocation of
the ulna
a fracture of the shaft of the ulna associated
with disruption of the proximal radioulnar joint
and dislocation of the radio-capitellar joint.
Nowadays, the term includes also fractures of
the olecranon combined with radial head
dislocation.
Monteggia fracture dislocation of the ulna
Usually the cause is a fall on the hand and
forced pronation of the forearm.
The radial head usually dislocates forwards
and the upper third of the ulna fractures and
bows forwards.
The forearm deformity is obvious but the
radial head dislocation may be missed.
X-Ray : Any apparently isolated fracture of the
ulna should raise the suspicion of a proximal
radial dislocation , if head of radius is
dislocated, it lies in a plane anterior to the
capitulum.
Ulnar Fracture , head of the radius no longer points
to the capitulum
Management of Monteggia Fracture
The secret of successful treatment is to
restore the length of the fractured ulna
In a child, closed reduction and plaster is
usually satisfactory .
In the adult , Reduction and Internal Fixation
In most cases the radial head will then
reduce by itself but if it does not then open
reduction is required.
Unreduced dislocation is the most common
complication in this kind of fractures
Galeazzi fracture dislocation of
the radius
a fracture of the distal third of the radius and
dislocation or subluxation of the distal
radioulnar joint.
It is much more common than the Monteggia.
Prominence or tenderness over the lower end
of the ulna is the striking feature
It is important also to test for an ulnar nerve
lesion, which is common.
 X-rays: The displaced fracture in the lower
third of the radius is obvious; check the
inferior radioulnar joint for subluxation or
dislocation.
Management of Galleazi Fracture
The important step is to restore the
length of the fractured bone
In children, closed reduction is often
successful
In adults, reduction is best achieved
by open operation and compression
plating of the radius.
An x-ray is taken to ensure that the
distal radioulnar joint is reduced and
stable
If it is reduced but unstable, the radio-ulnar
joint should be fixed with a Kirschner wire
(K-wire) and the forearm splinted in
an above-elbow cast for 6 weeks.
Thank You