Forearm Fractures: Monteggia and Galeazzi

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.

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.