Forearm fracture

Background

• Solitary fractures of the forearm are uncommon
  • Fractures usually occur at two or more sites or also involve a ligamentous injury

Fracture Types

Both Bone

Background

• Requires great amount of force (vehicular trauma, falls from height, direct blow)
• Neurovascular complications are unusual

Imaging

• Always consider wrist and elbow films
• Assess for angulation
  • AP view: radial styloid and radial tuberosity normally point in opposite directions
  • Lateral view: ulnar styloid and coronoid process normally point in opposite directions

Management

• Rule-out compartment syndrome
• ORIF

Isolated Radius (proximal)

Background

• Rare
• When occur, most are displaced
• Compartment syndrome is rare

Management

• Nondisplaced: cast immobilization
• Displaced: Internal fixation

Isolated Ulna (Nightstick)

Background

• Most often due to direct trauma

Management

• Stable: short arm cast
• Unstable: ORIF
  • >50% displacement
  • >10% angulation
  • Involvement of proximal 1/3

Monteggia Fracture-Dislocation

Background

• Ulna fx (proximal third) + radial head dislocation
• Easy to overlook the radial head dislocation (will result in worse outcome)

Clinical Features

• Pain/swelling at elbow
• Radial head may be palpable in an anterolatera or posterolateral location

Management

• Consult ortho in the ED; likely requires ORIF

Galeazzi Fracture-Dislocation

Background

• Radius fx (distal third) + distal radioulnar dislocation
• Caused by FOOSH or direct blow

Clinical Features

• Localized tenderness/swelling over distal radius/wrist

Diagnosis

• PA: May only show slightly increased distal radioulnar joint space
• Lateral: Ulna is displaced dorsally

Management

• Consult ortho in the ED; likely requires ORIF

Source

• Tintinalli