Forearm Fractures: Monteggia and Galeazzi

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary characteristic of a Monteggia fracture?

Fracture of the distal 1/3rd of the radius

Fracture of the upper third of the ulna with dislocation of the radius (correct)

Fracture of the lower third of the ulna

Displacement of the distal radius

Which treatment is necessary to prevent redisplacement of a Monteggia fracture?

Physical therapy alone

Conservative management with a cast

Surgical repair using ORIF (correct)

Immediate mobilization of the joint

Which statement regarding Galeazzi fracture-dislocation is incorrect?

It requires surgical intervention to prevent redisplacement.

It involves a fracture of the distal 1/3rd of the radius.

It does not commonly involve ulnar nerve injury. (correct)

It results from a rotational force.

During the rehabilitation phase of a both bone forearm fracture, what activity is restricted in Phase II (weeks 2-6)?

Forearm twisting movements Signup and view all the answers

What is one of the common causes of Colle's fracture?

A fall on a dorsiflexed (extended) wrist Signup and view all the answers

Which of the following best describes the common demographic affected by Colle's fracture?

Older women, especially those with osteoporosis Signup and view all the answers

In which phase of rehabilitation for a both bone forearm fracture are sutures or staples typically removed?

Phase I (weeks 0-2) Signup and view all the answers

What is a typical deformity associated with a Colle's fracture?

Dinner Fork deformity Signup and view all the answers

What is a common early complication associated with a Colles fracture?

Carpal tunnel syndrome Signup and view all the answers

What consequence does malunion of a Colles fracture typically lead to?

Permanent loss of wrist flexion Signup and view all the answers

Which of the following describes a characteristic of Complex Regional Pain Syndrome (CRPS 1)?

Swelling and vasomotor dysfunction Signup and view all the answers

Which factor contributes to the typical fracture pattern in a Colles fracture?

Comminution and impaction of the distal fragment Signup and view all the answers

Which of these is NOT considered a late complication of a Colles fracture?

Extensor pollicis longus injury Signup and view all the answers

What type of injury typically leads to Complex Regional Pain Syndrome (CRPS)?

Fractures or surgeries Signup and view all the answers

What happens to the radial styloid process in case of malunion in a Colles fracture?

It becomes foreshortened Signup and view all the answers

What is one of the primary treatments for managing Complex Regional Pain Syndrome?

Physical therapy Signup and view all the answers

What is the primary goal of physical therapy for CRPS?

Pain and edema control Signup and view all the answers

Which therapy involves the use of reflection to aid in movement?

Mirror therapy Signup and view all the answers

What is the appropriate timing for early mobilization after a surgically treated wrist fracture?

1 week post-surgery Signup and view all the answers

Which of the following is focused on during the early rehab phase post-fracture?

Pain and edema management Signup and view all the answers

What is a commonly performed stretch to increase ROM in the wrist?

Wrist extension or flexion stretch Signup and view all the answers

Which type of fracture may require an open reduction and internal fixation?

Significantly angulated and deformed fracture Signup and view all the answers

What characterizes a Smith fracture?

Palmar displacement of the distal fragment Signup and view all the answers

In early rehabilitation after a wrist fracture, which joint movements should be emphasized?

Shoulder, elbow, and finger movements Signup and view all the answers

Study Notes

Forearm Bone Shaft Fractures: Monteggia and Galeazzi

Monteggia Fracture-Dislocation: A fracture of the upper third of the ulna with anterior displacement of the upper ulna fragment and anterior dislocation of the radius. It also involves superior radio-ulnar joint dislocation. Requires ORIF (Open Reduction Internal Fixation) to prevent redisplacement.
Galeazzi Fracture-Dislocation: A fracture of the distal one-third of the radius with dislocation or subluxation of the inferior radioulnar joint. Causes rotational forces, resulting in forearm swelling, a prominent ulna head, and ulnar nerve injury. Conservative treatment may lead to redisplacement, thus ORIF is often needed.

Rehabilitation Following Forearm Fractures

Phase I (weeks 0-2): Patient is placed in a splint to protect surgical incisions. Sutures/staples are removed after two weeks. Elevation of the affected extremity is encouraged to manage swelling. Focus is on edema control and range of motion (ROM) of the fingers.
Phase II (weeks 2-6): Active and active-assisted ROM exercises for the elbow, forearm, and wrist. Repetitive forearm twisting is avoided.
Phase III (weeks 6+): Lifting and twisting restrictions are removed once union (bone healing) is achieved. Exercises focus on regaining pre-injury motion. Communication with the treating surgeon is crucial to determine when restrictions can be removed, considering weight-lifting limitations even if full union hasn't formed.

Distal Radial Fractures

Colles' Fracture: Transverse fracture of the distal radius, typically 2 cm proximal to the radiocarpal joint. Common in older individuals, frequently due to a fall on an extended wrist. A "dinner fork" deformity is a common characteristic.
Smith's Fracture: Transverse fracture of the distal radius with anterior (palmar) displacement of the distal fragment. Often the opposite direction of a Colles' fracture, resulting from a fall on a flexed wrist. A "garden spade" deformity typically occurs. Management is the same as for Colles fractures, except with emphasis on restoring wrist flexion range of motion.
Barton's Fracture-Dislocation: Intra-articular fracture of the distal radius with volar displacement (or sometimes dorsal displacement like Colles). Often requires open reduction and internal fixation (ORIF).
Radial Styloid Fracture (Chauffeur Fracture): A fracture of the radial styloid caused by compression of the scaphoid against the styloid. Non-displaced fractures are treated with a cast. Displaced fractures require surgical fixation.

Complications of Colles' Fracture

Early complications: radial artery injury, carpal tunnel syndrome, extensor pollicis longus injury.
Late complications: malunion, joint stiffness, Volkmann ischemic contracture, osteoarthritis, Sudeck's osteodystrophy (complex regional pain syndrome).

Treatment Options for Distal Radius Fractures

Undisplaced fractures: treated with a cast, often called a Colles' cast, with slight palmar flexion and ulnar deviation of the distal fragment.
Fractures with mild angulation and displacement: treated with closed reduction.
Fractures with significant angulation and deformity: require open reduction and internal fixation (ORIF) or external fixation.

Physical Therapy for Wrist Fractures

Early physical therapy prioritizes reducing pain and edema in the wrist and hand. Focus on range of motion, especially in the shoulder, elbow, and fingers as the starting point.
Wrist mobilization generally begins 7-8 weeks post-fracture. If the fracture is internally fixed, mobilization may start 1 week post-surgery.
Range of motion (ROM) exercises are increasingly important, beginning with passive range of motion, transitioning to active/active-assisted exercises, emphasizing extension and radial deviation. Progressive stretching can increase ROM.

Reflex Sympathetic Dystrophy (RSD - CRPS I)

It is a chronic pain syndrome, sometimes following a fracture involving an arm or leg. Pain is disproportionate to the initial injury severity and may involve swelling and altered blood vessel function in the affected area.
Treatment involves early recognition, intervention, physical therapy, and pain management.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the details of Monteggia and Galeazzi fracture-dislocations, including the mechanisms, treatment options, and rehabilitation phases. Learn about the critical differences between these types of fractures and their implications for recovery.