NAMED FRACTURES OF FOREARM ,WRIST & HAND

Dr. Jim Jacob Roy (House Surgeon , Ortho 3 Unit )

NAMED FRACTURES OF FOREARM ,

WRIST & HAND • Monteggia fracture dislocation• Galeazzi fracture dislocation• Colles’ fracture • Smith’s fracture• Barton’s fracture • Chauffer’s fracture• Bennett’s fracture • Rolando’s fracture • Boxer’s fracture

MONTEGGIA FRACTURE DISLOCATION

• This fracture is named after Giovanni Battista Monteggia ,an Italian surgeon.

MONTEGGIA FRACTURE DISLOCATION

• A fracture of the proximal third of ulna with dislocation of the head of the radius .

• MOI - Fall on an outstretched hand - Direct blow on the back of upper forearm

Classification system – Bado classification ( 4 types )

• 2 major types – Extension type & Flexion type

• TREATMENT Closed Manual Reduction & AE Slab

Application ( Monitor closely by weekly Check X rays because there is high chance of redisplacement)

Open Reduction & Internal Fixation using a plate

COMPLICATIONS

• Malunion (especially if treated conservatively) • Deformity & limitation of forearm

movements)

GALEAZZI FRACTURE DISLOCATION

• Named after Ricardio Galeazzi ,an Italian Orthopaedician .

• A fracture of the distal third of radius with dislocation or subluxation of the distal radio ulnar joint .

• MOI - Fall on an outstretched hand

• A FRACTURE OF NECESSITY

• TREATMENT

Closed Manual Reduction ( difficult to attain & maintain except in children)

Open Reduction & Internal Fixation with a plate

COMPLICATIONS

• Malunion • Deformity & limitation of supination &

pronation

COLLES’ FRACTURE • Named after Abraham

Colles , Professor of Anatomy, Surgery and Physiology at the Royal College of Surgeons in Ireland .

COLLES’ FRACTURE • A fracture at the distal end of the radius , at its

cortico cancellous junction with typical displacement .

• Commonest fracture in adults above 40 years of age .

• Common in women because of postmenopausal osteoporosis

• MOI - Fall on an outstretched hand

• Displacements –

Impaction of fragments Dorsal displacement Dorsal tilt Lateral displacement Lateral tilt Supination

• COMMON ASSOCIATED INJURIES

• Fracture of the styloid process of ulna • Rupture of the ulnar collateral ligament • Rupture of the triangular cartilage of the ulna • Rupture of the interosseous radio ulnar

ligament , causing radio ulnar subluxation

• Classical Deformity : “ Dinner Fork Deformity “

• TREATMENT

• If Undisplaced - Immobilisation in a BE Plaster Slab / Cast .

• If Displaced - CMR , followed by immobilisation in Colles’ cast .

• CMR - Relaxation of the forearm muscles Disimpaction of the fragments Correction of the displacement Plaster application

• Check X ray

• Encourage active finger movements & elbow & shoulder movements through their full range

• In Young Individuals ,

o Percutaneous Transfixation using K wires

o External fixator

o Fixation using LCP

• COMPLICATIONS

Stiffness of joints (Finger stiffness is the commonest complication)

Malunion ( Correct malunion by osteotomy if there is an ugly deformity / if it hampers the day to day activities of the individual)

Subluxation of the IRUJ – painful & restriction of wrist movements ( Excision of the lower end of ulna – Darrach’s resection – in selected cases)

Carpal Tunnel Syndrome ( median nerve is compressed in the carpal tunnel by the encroaching fracture callus)

Sudeck’s osteodystrophy – Colles’ fracture being the commonest cause of Sudeck’s osteodystrophy in upper limb ( Intensive Physiotherapy is required )

Rupture of EPL - either due to loss of blood supply to the tendon at the time of injury or due to friction on th tendon during its movements over the malunited fracture ( needs tendon transfer)

SMITH’S FRACTURE• Named after Robert William Smith ,an Irish

surgeon .• Reverse of Colles’ fracture

• Uncommon

• Distal fragment displaces ventrally & tilts ventrally

• TREATMENT – CMR & plaster immobilsation for 6 weeks

BARTON’S FRACTURE • Named after John Rhea Barton ,an American

surgeon.

• An intra articular fracture of the distal end of radius – the fracture extends from the radius to either its anterior or posterior cortices .

• 2 types – Volar & Dorsal ( depending on the displacement of the distal fragment)

• TREATMENT

• Closed Manual Reduction & Plaster immobilisation

• Open reduction & internal fixation with a plate ( if CMR fails & as a primary choice in young adults with significantly displaced fractures)

CHAUFFER’S FRACTURE( Backfire fracture /  Hutchison fracture)

• A fracture of the radial styloid process

• The name originates from early chauffeurs who sustained these injuries when the car back-fired while the chauffeur was hand-cranking to start the car.

• The back-fire forced the crank backward into the chauffeur's palm and produced the characteristic styloid fracture.

BENNETT’S FRACTURE DISLOCATION

• Named after Edward Hallaran Bennett , Professor of Surgery at Trinity College of the University of Dublin .

• an An oblique intra articular fracture of the base of the 1st metacarpal with subluxation or dislocation of the metacarpal .

TREATMENT -

• Closed reduction & percutaneous K wire fixation with the help of an image intensifier .

• Open reduction & internal fixaion with a K wire .

• COMPLICATIONS

• Osteoarthritis of the joint – persistent pain & loss of grip ( excision of trapezium in painful arthritis)

ROLANDO’S FRACTURE • Named after Silvio

Rolando .

• A complete articular , T or Y shaped fracture of the 1st metacarpal .

• TREATMENT – Reduction & fixation with K wire & immobilsation in a thumb spica for 3 weeks

BOXER'S FRACTURE • a colloquial term for

a fracture of one of the metacarpal bones of the hand.

• Classically, the fracture occurs transversely across the neck of the bone, after the patient strikes an object with a closed fist.

SUMMARY• Monteggia fracture dislocation

• Galeazzi fracture dislocation• Colles’ fracture • Smith’s fracture

• Barton’s fracture • Bennett’s fracture • Rolando’s fracture

INTRA ARTICULAR FRACTURES

FRACTURES OF RADIUS

FRACTURE OF ULNA