forearm and wrist fractures

8/12/2019 Forearm and Wrist Fractures

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Forearm and WristFractures

By Dr Fiona Hill

HMO2


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Key Learning Points

1. www.eorif.com

2. AlwaysXR the joint above and below #.

3. # Ulnar = check the radial head

# Radius= check the druj

4. GFR: Galeazzi = Fractured Radius

BUM: Broken Ulnar = Monteggia

5. www.imagingpathways.health.wa.gov.au


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Summary of Fractures

Galeazzi

Monteggia

Isolated ForearmFractures

Colles Fracture

Smiths Fracture Fracture of Radial

Styloid


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Forearm Fractures 101

Radius and ulnar are bound together by:

Annular ligament

Interosseus membrane

Radioulnar ligaments and triagular fibrocartilage.

With a direct blow you can break either

isolated, however more likely w/ indirect

(i.e. FOOSH) to damage both.


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www.imagingpathways.health.wa.gov.au
http://www.imagingpathways.health.wa.gov.au/http://www.imagingpathways.health.wa.gov.au/


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www.imagingpathways.health.wa.gov.au
http://www.imagingpathways.health.wa.gov.au/http://www.imagingpathways.health.wa.gov.au/


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Galeazzi

GFR: Galeazzi Fractured Radius

Definition:Fracture of the radial shaft(usually distal 1/3) with dislocation of

the distal radioulnar joint

Clinically:Pain and swelling inforearm and wrist. Forearm rotationvery painful.

NV exam, evaluate for compartmentsyndrome, evaluate soft-tissueenvelope, wrist evaluation.


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Galeazzi part 2

Radiologically:A/P and Lateral offorearm +/- elbow, wrist.

Mx:ORIF of the radius is indicated in

all cases. Further Mx depending on stability of

distal radioulnar joint.

Assoicated injuries/DDx:

Ulnar Styloid Fracture TFCC Tear

DRUJ Instability


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Monteggia

BUM: Broken Ulnar Monteggia

# ulna with dislocation of theradial head.

1in14 of forearm #

More common in children.

Adult injuries are typically highenergy, fall from heights or MVA.

Clinical Evaluation: Pain andswelling in the elbow and ulnarborder of the forearm. ROMlimited by pain. NV exam, evaluate for

compartment syndrome,evaluate soft-tissue envelope,wrist evaluation.


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Monteggia

Radiology: A/P and Lateral offorearm +/- elbow, wrist.

Always suspect a radial headdislocation in an ulnar #.

A line drawn along the axisof the radius should passthrough the capitellus onboth lateral + AP views.

MX: ORIF generally.


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Isolated Ulnar/Radius

Most fractures of theulnar/radius shaft arecaused by direct blows andresult in minimal soft-tissueinjury.

Generally obvious grossdeformity NV exam, evaluate for

compartment syndrome,evaluate soft-tissue

envelope, wrist evaluation.

A/P and Lateral of forearm+/- elbow, wrist.


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Isolated Ulnar/Radius

Ulnar Shaft Fracture Associated Injuries /Differential Diagnosis Monteggia fracture-dislocation.

Radius and ulna shaft fracture.

Galeazzi Fracture

Mx: Depends on if its a distal, middle or proximal third. Plus if its displacedor not.

Can be conservativeor ORIF.

Fracture Complications

a Superficial wound infection

Nonunion: (incidence is higher for comminuted ordisplaced fx's)

Hardware failure

Malunion

Painful hardware

Ulnar nerve palsy

Radial nerve palsy


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Distal Radial Fracture (+ Colles

Fracture)

Most commonly women age 60-70.

90% caused by compression on dorsiflexed

wrist.

90% of distal radius fractures are Colles

Fractures


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Colles Fracture

Definition:Dorsally displaced fracture ofthe distal radius generally occuring 2-3 cmproximal to the radiocarpal joint.

Most common #, seen mainly in middleaged and elderly women.

FOOSH most likely cause.

Clinical Evaluation: Pain and swelling inwrist, often gross deformity in wrist. NV exam, evaluate for compartment syndrome,

evaluate soft-tissue envelope

Evaluated for carpal tunnel syndrome

Evauate for possible scaphoid injury.

Deformities include: occurs throughmetaphysis, dorsal displacemnt of thedistal fragment, anterior angular of distalfragment, impaction between the distalfragment and the shaft. There is lateraldisplacement of the distal fragment.


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Colles Fracture

XRs:Forearm XR AP/Lat + wrist PA/lat +/- elbowAP/Lat.

Mx: Can be generally managed with closed reductionwith well molded cast/splint. Significant angulation and deformity may require an open

reduction and internal fixation.

An open fracture will always require surgical intervention.

Consider Osteoporosis evaluation and management.

Complications of Colles/ DDx: Galeazzi Fracture: highly associated with distal 1/3 radial

shaft fractures Ulnar styloid fracture

DRUJ Instability

Compartment syndrome @1%

Median nerve injury Tendon injury,attritional EPL rupture.

Scapholunate ligament tear.

TFCC injury, up to 50% when ulnar styloid fx also present

Carpal ligament injury.


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Smiths Fracture

Definition:Distal radial fragment is tiltedinto a posteior angulation and may bedisplaced ventrally (volar). (ReverseColless)

Mechanism:Direct blow to thedorsalforearm or falling onto flexed wrists, (as opposed to a Colles' fracture = falling

onto wrists in extension.)

Smith's fractures are less commonthan Colles' fractures.

Mx: Undisplaced fracture = cast alone.

Mild angulation and displacement mayrequire closed reduction.

Significant angulation and deformity mayrequire an open reduction and internalfixation.

An open fracture will always require surgicalintervention.

Consider Osteoporosis evaluation and

management


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# Radial Styloid Fracture

Isolated radial styloid #.Displacemnt is normally slight.

Mechanism:FOOSH or

kickback injury.

Mx: Manipulation rarely of value.

If minimal displacement,Colles type plaster.

If distal articular surfaceinvolved may need fixation.

Sudecks atrophy (complexregional pain syndrome) is acommon complication.


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Key Learning Points

1. www.eorif.com

2. AlwaysXR the joint above and below #.

3. # Ulnar = check the radial head# Radius= check the druj

4. GFR: Galeazzi = Fractured Radius

BUM: Broken Ulnar = Monteggia

5. www.imagingpathways.health.wa.gov.au


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Thank you!

forearm and wrist fractures

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