Posterior dislocation is the most common, caused by a fall on an outstretched hand with hyperextension and rotation leading to failure of the anterior capsule and medial collateral ligaments. Prosthetic replacement is recommended if there is evidence of IOL or DRUJ symptoms, or concomitant dislocation.Įlbow or ulnohumeral dislocations may be posterior, anterior, medial, lateral, or divergent, based on the position of the ulna relative to the humerus. Therefore, radial head excision is recommended. In type III fractures, the radial head is not repairable by definition. With evidence of interosseous ligament or DRUJ injury, radial head excision may lead to proximal migration of the radius and DRUJ symptoms, so ORIF versus prosthetic replacement of the radial head should be considered. In low-demand patients, partial or complete radial head excision may be considered. ORIF should be considered in young, high-demand patients. If there is a mechanical block, crepitus, or joint incongruity, surgical treatment is indicated. If there is no mechanical block and displacement is minimal, then the fracture may be treated closed, similar to a type I. Type II fractures may be treated several ways. Active forearm rotation is begun immediately, and range of motion should steadily improve over 2-3 months. Type I fractures may be treated with a sling with or without a short (3-4 days) course of immobilization. Treatment of radial head fractures is dependent on fracture characteristics as well as the associated injuries in the surrounding tissues. If non-displaced (2mm, and type III fractures are highly comminuted fractures. Nightstick fractures are significantly more stable than both-bone forearm fractures. If the DRUJ is unstable after anatomic reduction, a radioulnar pin may be used to hold reduction. If the joint is not reducible, fracture reduction should be reassessed soft-tissue interposition may require open reduction. Anatomic reduction of the fracture is usually successful in reducing the dislocations associated with Galleazi or Monteggia fractures. Intramedullary nailing is rarely used in adults. External fixators may be indicated for contaminated open fractures and fractures with significant soft-tissue compromise.
Closed reduction is reserved for those with contraindications to surgical treatment, and unsatisfactory results may be expected up to 71% of the time. Most fractures of the radius and ulna in adults are displaced, and open reduction and internal fixation is the treatment of choice. Eponyms are associated with various fracture patterns: nightstick fractures refer to isolated ulnar shaft fractures Monteggia fractures are ulnar shaft fractures with radial head dislocation Galeazzi fractures are distal third radius fractures with dislocation of the DRUJ. CT may be helpful in evaluating the DRUJ.įractures are described by location within the bone (divided into thirds), displacement, angulation, and pattern. Radiographs of the opposite forearm may be useful in evaluating alignment. AP and lateral radiographs of the forearm, wrist and elbow should be obtained while the fractures will usually be evident, subtle malalignment of the DRUJ and radial head should be evaluated. A careful neurovascular exam should be documented, and repeat neurovascular exams are important, as these injuries are susceptible to compartment syndrome. Tenderness to palpation and crepitus may be elicited, but are usually unnecessary for diagnosis. On exam, pain and deformity are usually obvious. This bow is important in allowing the radius to rotate around the ulna in pronation and supination. The radius bows laterally approximately 15mm at its midpoint. The interosseous ligament or membrane runs between the bones, and helps maintain their relative positions, with a strong central band providing the majority of the support. Distally, they contact each other at the distal radioulnar joint (DRUJ), which is stabilized by the triangular fibrocartilage complex (TFCC). These bones are in contact proximally at the proximal radioulnar joint, where they are bound by the elbow joint capsule and the annular ligament, which wraps around the radial neck. The forearm is composed of the relatively straight ulna and the bowed radius. Fracture of one or both of the radius or ulna may be seen, along with various patterns of dislocation. Fractures of the shaft of the radius and ulna usually occur from a direct blow to the arm, as in a motor vehicle accident, motorcycle accident, assault, gunshot, or sports-related, or in a fall from a height.
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