Forearm fractures

• They arise by mechanism:
  • direct – only one bone may be injured;
  • indirect – always both bones are injured or Monteggi and Galeazzi.
• Dislocation of the radius according to the amount of fracture:
  • in the upper third - traction of the supinator and biceps;
  • in the lower third - pronator traction.

Colles fracture

Classification

1. Fractures of the proximal radius – head fractures (Mason I–III), neck fractures;
2. Fractures of the proximal ulna – fractures of the olecranon (Colton I–III), fracture of the proc. coronoideus (st. 1-3);
3. fractures of the diaphysis of the radius and ulna:
   • associated fractures of the radius and ulna;;
   • isolated fractures of the radius and ulna;
   • Monteggia fracture;
   • Galeazzi fracture;
4. fractures of the distal radius:
   • extraarticular:
     • no dislocation;
     • with extensional dislocation (Colles fracture);
     • with flexion dislocation (Smith's fracture);
   • partially intra-articular:
     • sagittal dislocation;
     • dorsal dislocation (Barton I);
     • ventral edge avulsion (Barton II);
   • intra-articular comminuted (Melon).

Complications

• Pseudoarthrosis;
• compartment syndrome;
• Volkmann's ischemic contracture;
• synostosis between radius and ulna.

Treatment

Conservative

• Possible for non-displaced fractures of both bones (circular cast fixation from mid-arm to metacarpal heads, elbow in 90° flexion, forearm in supination for fractures in the upper half, in pronation in the lower half, for 12-16 weeks).
• For isolated fractures of one forearm, cast fixation for 8 weeks - for non-isolated fractures of the ulna and upper two-thirds of the radius (in supination), fractures of the lower third of the radius indicated for operative treatment.
• For fractures of the distal radius (Colles, Smith), plaster fixation for 6 weeks - from the metacarpal heads below the elbow, with the wrist in ulnar duction and flexion (Colles) or extension (Smith).

Surgical

• Recommended for isolated fractures (the second, unbroken bone then acts as a spacer and leads to the formation of a subluxation); Galeazzi and Monteggi fractures are also indicated, as are all dislocated and open fractures.
• Autocompression splints and intra-articular fixation with spikes are mainly used, external fixation in open and splinter fractures, splints, K-wires, screws, external fixation in distal forearm fractures.

Links

Related articles

• Ulna
• Radius

Zdroj

• PASTOR, Jan. Langenbeck's medical web page [online]. [cit. 2022-17-12]. <http://langenbeck.webs.com>.