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Forearm (Monteggia Fracture (Mechanism (direct blow on the posterior…
Forearm
Monteggia Fracture
- fracture of the proximal ulna with radial head dislocation and proximal radioulnar joint injury
- more common and better prognosis in the pediatric age
Mechanism
- direct blow on the posterior aspect of the forearm
- hyperpronation
- fall on the hyperextended elbow
Clinical Features
- pain, swelling, decreased rotation of forearm ± palpable lump at the radial head
Investigations
x-ray: AP, lateral elbow, wrist and forearm
Treatment
- ORIF of ulna with in direct radius reduction in 90% of patients (ORIF of radius if unsuccessful)
- splint
- pediatrics: attempt closed reduction and immobilization in plaster with elbow flexed for Bado Type I-III, surgery for Type IV
Specific Complications
PIN: most common nerve injury, radial head instability / redislocation, radioulnar synostosis
-
Galeazzi Fracture
- fracture of the distal radial shaft with disruption of the DRUJ
- most commonly in the distal 1/3 of radius near junction of metaphysis / diaphysis
-
Features
- pain, swelling, deformity and point tenderness at fracture site
Treatment
- all cases are operative: ORIF of radius
Investigations
x-ray: AP, lateral elbow, wrist and forearm
Nightstick Fracture
- isolated fracture of ulna without dislocation of radial head
- Due to direct blow to forearm
- Treatment:
non-operative: non-displaced-->below elbow cast
operative-->displaced-->ORIF