Forearm Bone Shaft Fractures Quiz

Forearm Bone Shaft Fractures

• Monteggia fracture: A fracture of the upper third of the ulna with anterior displacement of the upper ulnar fragment and anterior dislocation of the radius. It's also a proximal ulnar fracture with superior radio-ulnar joint dislocation. Requires ORIF (open reduction and internal fixation) to avoid redisplacement.

• Galeazzi fracture-dislocation: A fracture of the distal one-third of the radius with dislocation or subluxation of the inferior radioulnar joint. It is typically caused by rotational forces. Symptoms include swelling in the lower forearm, a prominent ulna head, and ulnar nerve injury. Non-operative treatment may lead to redisplacement, so surgical intervention is often required.

Distal Radial Fractures

• Colles' fracture: A transverse fracture of the distal radius, usually 2 cm proximal to the radiocarpal joint. It's one of the most common fractures affecting primarily older people, especially women due to osteoporosis. It results from a fall on a dorsiflexed (extended) wrist, often causing a "dinner fork" deformity.

• Smith's fracture: Also known as reverse Colles' fracture or a Goyrand fracture. This fracture is the opposite of a Colles' fracture, resulting in anterior (palmar) displacement of the distal radius fragment. The fracture occurs proximally to the wrist joint, resulting in a fall on a flexed wrist. It typically causes a "garden spade" deformity.

• Barton's fracture-dislocation: An intra-articular distal radius fracture with either volar or dorsal displacement. Management typically involves ORIF (open reduction and internal fixation).

• Radial styloid fracture (chauffeur fracture): A fracture to the radial styloid process, often caused by compression from the scaphoid bone. Non-displaced fractures are treated with cast immobilization; displaced fractures require surgical fixation.

Fracture Rehabilitation

• Phase I (weeks 0-2): Focus on protecting surgical incisions, elevating the affected extremity to reduce swelling, and controlling edema. Sutures or staples are removed at week two.

• Phase II (weeks 2-6): Emphasize active and active-assisted range of motion (ROM) exercises for the elbow, forearm, and wrist. Avoid repetitive twisting motions of the forearm.

• Phase III (weeks 6+): Lifting and twisting restrictions are lifted once bone union has occurred. Focus on regaining preoperative mobility and weight-bearing restrictions can also be removed following consultations with the treating surgeon. Work on increasing range of motion and performing strengthening exercises.

Complications

• Early Complications (Colles' fracture): Radial artery injury, carpal tunnel syndrome, extensor pollicis longus injury.

• Late Complications (Colles' fracture): Malunion (poor bone healing), joint stiffness, Volkmann ischemic contracture, osteoarthritis, and Sudeck's osteodystrophy (complex regional pain syndrome).

• Malunion: A Colles' fracture rarely heals without some residual malalignment. The radius often becomes foreshortened, the radial styloid process may be shortened, and the distal end of the radius is commonly angulated and displaced dorsally. This malalignment may lead to permanent losses of wrist flexion and ulnar deviation, and pronation. Radial displacement may also have a minor impact on motion.

Reflex Sympathetic Dystrophy (RSD) 

• RSD is a clinical syndrome of variable course and unknown cause characterized by pain, swelling, and vasomotor dysfunction in an extremity.

• The pain is usually disproportionate to the initial injury(surgery, stroke, heart attack).

• Treatment involves early recognition, early intervention with physical therapy, and use of anti-inflammatory agents and nerve blocks.

• Physical therapy for RSD focuses on pain and edema control, active upper limb exercises (with automated passive exercises to improve range of motion). Functional activities are also considered, as well as aquatic therapy, mirror therapy (to improve mirror feedback and desensitize the injury through stimuli), and desensitization techniques (applying varying pressures, stimuli of varying materials, heat or cold therapy).

Treatment of Forearm Fracture

• Undisplaced fracture: Can be treated by cast immobilization, specifically a cast applied to a wrist angled slightly palmarly, with an ulnar deviation, also known as a colles cast.

• Fractures with mild angulation and displacement: Requires closed reduction.

• Fractures with significant angulation and deformity: Requires open reduction and internal fixation or external fixation.

Physical Therapy Guide

• Early focus: Limiting pain and edema in the wrist and hand. Emphasize movement in the shoulder, elbow, and fingers in all rehabilitation phases.

• Mobilizing the Wrist: Mobilization focus can occur 7-8 weeks after fracture. Early mobilization can start a week after surgery if internal fixation is applied.

Test your knowledge on forearm bone shaft fractures including Monteggia and Galeazzi fractures. This quiz covers their definitions, causes, symptoms, and treatments. Ideal for medical students and professionals looking to refresh their understanding of these common injuries.