Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Traumatology and orthopaedics
Acute Trauma Management
Trauma in perspective
Principles of Primary Trauma Care
Six phases of Primary Trauma Care
Procedures
Orthopaedic Techniques
Traction
Casts and Splints
Application of external fixation
Diagnostic imaging
Physical therapy
Crania burr holes
Orthopaedic Trauma
Upper extremity injuries
The hand
Fractures of the pelvis and hip
Injuries of the lower extremity
Spine injuries
Fractures in children
Amputations
Complications
War related trauma
General Orthopaedics
Congenital and developmental problems
Bone tumours
Infection
Degenerative conditions
Trauma in Perspective
 

> CLAVICLE FRACTURES
> ACROMIAL-CLAVICULAR JOINT SEPARATION
> SHOULDER DISLOCATION
> PROXIMAL HUMERUS FRACTURES
> HUMERAL SHAFT FRACTURES
> SUPRACONDYLAR FRACTURES OF THE HUMERUS
> OLECRANON FRACTURES
> FRACTURES OF THE RADIAL HEAD AND NECK
> ELBOW DISLOCATION
> FOREARM FRACTURES
> DISTAL RADIUS FRACTURES
> CARPAL FRACTURES AND FRACTURE DISLOCATIONS





FOREARM FRACTURES

Forearm fractures are caused by direct trauma or by a fall on the outstretched arm with an accompanying rotatory or twisting force.

Evaluation

The forearm is swollen and tender, with limited motion. Evaluate vascular function by checking pulse, capillary refill and skin temperature of the hand. Check sensory and motor function of the radial, median and ulnar nerves. X-rays confirm the nature of the fracture.

Monteggia fractures involve the proximal ulna with dislocation of the radial head, usually in the anterior direction (Figure 18.25).

Figure 18.25
Figure 18.25


Galeazzi fractures are the reverse of the above, with a fracture of the distal radius and a dislocation of the radial-ulnar joint at the wrist. The radius fracture is usually oblique, causing the bone to shorten (Figure 18.26).

Figure 18.26
Figure 18.26


Treatment

:: Midshaft fractures may involve one or both bones; treat single bone fractures with minimal displacement in a long arm cast, with the elbow at 90 degrees and the forearm in neutral rotation
:: Treat displaced fractures by closed reduction and application of a long arm splint; perform the reduction by applying traction to the fingers and manipulating the forearm with the elbow bent to 90 degrees. Apply counter-traction above the bent elbow (Figure 18.27)
Figure 18.27
Figure 18.27

:: Reduce Monteggia fractures as described for displaced fractures (Figure 18.28). Apply a long arm cast in supination. It is possible to obtain a satisfactory reduction in children, but adults often require surgical treatment.
Figure 18.28
Figure 18.28

:: Treat Galeazzi fractures as described for midshaft fractures. They are unstable and often need surgical stabilization.


Rehabilitation

Begin motion out of the cast at 6–8 weeks.

> CLAVICLE FRACTURES
> ACROMIAL-CLAVICULAR JOINT SEPARATION
> SHOULDER DISLOCATION
> PROXIMAL HUMERUS FRACTURES
> HUMERAL SHAFT FRACTURES
> SUPRACONDYLAR FRACTURES OF THE HUMERUS
> OLECRANON FRACTURES
> FRACTURES OF THE RADIAL HEAD AND NECK
> ELBOW DISLOCATION
> FOREARM FRACTURES
> DISTAL RADIUS FRACTURES
> CARPAL FRACTURES AND FRACTURE DISLOCATIONS



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  Kep Points  
Forearm fractures are complex fractures which, in adults, usually require surgical stabilization


They occur as three major types:
– Midshaft fractures
– Proximal (Monteggia) dislocations
– Distal (Galeazzi) fracture dislocations



 
The most common complication is loss of forearm rotation.