The document discusses fractures of the forearm and their treatment. It summarizes that the forearm functions as a joint with six articulations. Forearm fractures can result in deformities like shortening, angulation, and loss of alignment if not treated properly. Treatment goals are anatomical reduction, restoration of length and rotation, and early return of function. Plate fixation is the gold standard and provides stable fixation, allowing early motion to restore function with high union rates over 95%.
2. Objectives
โข Review the concept of the forearm as a joint
โข Discuss the assessment, problems and options for
treatment of forearm fractures
โข Review the options for surgical approaches
โข Discuss complications and outcomes
8. Investigations
โข X-ray in two planesโmust include both joints
โข CTโrarely indicated
โข MRIโuseful for assessing damage to articular cartilage
of distal radioulnar joint
โข Angiographyโvital in cases involving vascular trauma
11. Fracture with joint disruption
Monteggia fractures
โข Ulnar shaft fracture with
- Dislocation of radial head
- Types I โ IV depending on direction of radial head
dislocation
12. Fracture with joint disruption
Monteggia fractures
Line drawn through radial head
and shaft should line up with the
capitellum in all views
13. Fracture with joint disruption
Galeazzi fractures
โข Radial shaft fracture with:
- Dislocation of distal ulna
- Multiple variants in
location of radius fracture
14. Personality of fracture
โข Soft-tissue damage
โข Degree of fracture displacement
โข Degree of comminution
โข Degree of joint involvement
โข Osteoporosis
โข Nerve/blood vessel injury
15. Goals of treatment
โข Anatomical reduction
โข Restore ulnar & radial length
โข Reduce/stabilize joints
โข Restore rotational alignment
โข Repair soft-tissue injuries
โข Restore normal function
18. Indications for operative treatment
โข Combined fractures of ulna and radius
โข Displaced isolated fracture of either bone
โข Monteggia and Galeazzi
โข Every open fracture
23. Operative treatmentโimplant
โข LC-DCP 3.5 (limited-contact dynamic compression plate)
- Anatomical reduction
โข LCP 3.5 (locking compression plate)
- Restoration of length, axis, and alignment
โข At least 3 screws in each main fragment!
24. Plate fixation
โข The โGold Standardโ treatment for most diaphyseal
forearm fractures
โข Stable, strong, anatomical fixation
โข Union rates > 95%
25. Tips for operative surgery
โข Begin with easiest fracture
โข Look for elbow and wrist joint
โข Be aware of rotation of radius
โข Test function of forearm joint after fixation
26. Plate fixationโreduction preserving soft tissue
โข Minimize periosteal stripping
โข Narrow retractors placed to
- avoid penetration of interosseous
- membrane
โข Extreme care with butteryfly
- fragments
27. Timing of surgery
โข Splint application with elective scheduling for
uncomplicated closed fractures
โข Immediate fixation for:
- Open fractures
- Impending open fractures
- Compartment syndrome
- Unreducable dislocations
โข Easier fracture reduction with early surgery, especially if
shortening is present
28. Postoperative care
โข Avoid prolonged immobilization
โข If you fix it internally, do not fix it externally
โข Immobilize the minimum time needed to protect the soft
tissues
โข Dislocations may require immobilization
โข Begin early active ROM
29. Problems
โข Soft-tissue loss
โข Infection
โข Synostosis 2,6โ6,6%
โข Nonunion 3,7โ10,3%
โข Refracture after implant removal up to 25%
30. Results of plate fixation
MW Chapman et al (1989) J Bone Joint Surg
โข Healing 98%
โข Excellent to satisfactory 92%
โข Infection rate 2.3%
โข Refracture rate 2.3%
31. External fixator
โข Indications
- Bridging fixation
- Types IIIB & C open fractures
- Later revision to internal
fixation when soft tissues
allow
- NOT definitive fixation
32. Intramedullary nailing
Indications
โข Not routinely used
โข Problems of rotational instability, loss of radial bow,
shortening, and nonunion
โข May be useful when soft tissues compromised
โข Children
โข Pathologic fractures or impending fractures where the
device protects the whole bone
34. Summary
โข Analysis of fracture mechanism and associated soft-
tissue lesions are vital to allow adequate treatment
planning
โข Complete reconstruction of anatomy is essential to
restore normal function
โข Stable fixation with long plates and early movement are
the keys to success
โข Plate fixation gives good results