บรรยายในการประชุมวิชาการประจำปีของชมรมศัลยแพทย์ทางมือแห่งประเทศไทยครั้งที่ 34 วันพฤหัสบดีที่ 15 มีนาคม 2561 ณ คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี

1. Forearm Fracture
“A Wednesday Child in Upper Extremity Injury”
Nattakul Yamprasert, MD
Department of Orthopaedics
Maharat Nakhon Ratchasima hospital
The 34th Annual Hand Meeting
“The Interactive Meeting”

2. Overview
• Functional Anatomy
• Approach
• Fixation technique
• Case Presentation

3. Axis of
Forearm
Rotation
Supination

4. Axis of
Forearm
Rotation
Pronation

5. Radial Shaft Fracture
•Nonoperative treatment for nondisplaced /
minimally displaced fracture
•In comminuted fracture or segmental fracture,
radiographs of opposite limb may be used,

6. Radial Shaft Fracture
• Radial bow can be evaluated in AP view
• Radial styloid (lateral)/bicipital tuberosity (medial)

7. Galeazzi’s Fracture
•After fixation of radius, immobilization in
supination
•Interosseous pinning in grossly unstable DRUJ
•Four cortical pinning for easy removal

8. Isolated Ulnar Fracture
• Result of direct trauma “nightstick fracture”
• Most fracture of midshaft & distal ulna treated
successfully with nonoperative treatment
• Angulation < 10 degrees
• Displacement < 50%

9. • Group 1 : Immediate mobilization
• Group 2 : Short-arm cast
• Group 3 : Long-arm cast
“No clear differences in outcome between interventions”

10. Indications for Operative Treatment
•Angulation > 10 degrees
•Displacement > 50 % (at least partial
disruption of IOM is present)

11. Surgical Approach
•Anterior approach
•Posterior approach
•Direct ulnar approach

12. Anterior Approach (Henry)
•Almost all level of fracture
•Difficult plating at uppermost part
•LABC and superficial radial nerves
•No need for PIN exploration, but…
•Avoid placing curved retractor to
dorsal surface of proximal radius

13. Posterior Approach (Thompson)
• Proximal 1/3 of radius
• Identify PIN

14. Direct Ulnar Approach
• Flat dorsal surface at middle & distal
• Ulnar nerve & artery under FCU muscle
• Dorsal branch of ulnar nerve about 1-4 cm proximal to
ulnar styloid

15. Bone Fixation

16. Plate & Screws
•3.5 mm DCP is popular in most forearm fractures
•LCP in comminuted fracture/osteoporosis bone
•Pre-contour Plate or 3.5 mm reconstruction plate
in long segmental fracture

17. •Less soft tissue dissection
•Lower rate of refracture after implant removal
•Higher rate of nonunion/malunion
Intramedullary Nail

18. Contraindication
•Active infection
•Previous malunion
•Intramedullary canal smaller than implants
•Fracture extension to metaphysis or articular
surface
Intramedullary Nail

19. •Temporary stabilization
•Severe contamination
•DCO
External Fixation

20. When long plate not available

21. Small T-buttress plate 3.5 mm DCP

22. Layered Plate Technique

24. Postop. 3 months

25. What about MIPO in
Forearm Fracture?

29. Postop. 8 weeks

30. Postop. 8 weeks

33. Postop. 3 months

34. Take Home Messages
•Forearm is the link between elbow and wrist,
disability of the forearm affects functions
of upper extremity as a whole.