![Both Bone Forearm Fracture ,[object Object],[object Object],[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
More Related Content
Recently uploaded
Recently uploaded (20)
Featured
Featured (20)
Jayden bbffx
- 11. Surgery?
Editor's Notes
- See anything abnormal here? This is what we call a Both Bone Forearm Fracture, it is always a surgical indication.
- This is an Anterior/Posterior film in the ED immediately after presentation. Notice the incidental fragment of the medial condyle (middle bony prominence at the elbow) at the bottom of the film. That can be fixed by immobilization alone but the rest of this mess can’t.
- Lateral film in the ED. Looks like a pterodactyl wing.
- In any fracture you need to get pics of the joints and bones above and below the fracture to make sure you don’t miss anything. This is called a dedicated wrist film which fortunately is normal. No broken wrist bones.
- Lateral dedicated wrist film. Second view to make sure you don’t miss anything.
- This is a film post-reduction in the ED. The resident did a pretty good job on the reduction. Note the splint around the arm.
- Lateral view post-reduction.
- All splinted and ready to roll. We went home that night and were supposed to follow up with the surgeon in 2 days to schedule the surgery. We got home and into bed by 1:00 am but the resident called at 2:15 because they were unable to rule out his fracture as open. Open fractures are when bone comes through the skin and therefore is susceptible to infection and other terrible complications. The surgery was then scheduled as emergent and we went to the OR at 5:00.
- This is not Jayden. Normally when we fix both bone forearm fractures we have to plate them. Note the large incision in the picture on the anterior (palmar side) of the forearm to fix the Radius. Then to add insult to injury we make another large incision on the back of the forearm to fix the Ulna. Jayden was scheduled for this procedure. He would have plates for a year and then have to go back in to surgery to have them removed. It is a huge double surgery to fix this kind of fracture.
- In the OR Jayden’s arm was successfully reduced and the decision was made to nail his ulna, splint and cast him instead of doing plating. He was very fortunate not to have the dual incision surgery. Instead they made a small incision (5 mm) at the elbow and pounded a nail into the marrow cavity. This is an Anterior/Posterior fluoroscopic film done intra-op to make sure the nail is in the marrow cavity and captures the fracture distally. As you can see, the radius was reduced but not fixed.
- This is a Lateral fluoroscopic film done intra-op to make sure the nail is in the marrow cavity and has captured the fracture distally. This second intra-op film is taken to ensure that the nail is truly in the cavity.
- Anterior/Posterior plain film post-op in recovery room. Nail in the Ulna. Radius reduced and approximated, no fixation. You can see that the radius is not quite anatomical but it will heal to near anatomical none the less. Jayden will have to be extremely careful not to dislocate the unfixed radius or he will have to have the plates put in.
- Lateral plain film post-op in recovery room. Just another view to make sure that the nail is in place and the fractures are secured in the splint. The nail will be pulled out in an outpatient surgery after the bones are healed.
- Going home. Thanks for watching, and we will see you next time on another episode of Jayden Does Something Stupid .