Forearm Bone Shaft Fracture PDF

Forearm bone shaft fracture Monteggia fracture and Galeazzi fracture-dislocation  MoNtegia fracture dislocation It is a fracture of the upper third of the ulna with anterior displacement of the upper fragment of the ulna and anterior dislocation of the radius. In short, Monteggia’s...

Forearm bone shaft fracture Monteggia fracture and Galeazzi fracture-dislocation  MoNtegia fracture dislocation It is a fracture of the upper third of the ulna with anterior displacement of the upper fragment of the ulna and anterior dislocation of the radius. In short, Monteggia’s fracture is the proximal ulnar fracture with superior radio-ulnar joint dislocation It requires ORIF or it will redisplace  Galeazzi fracture-dislocation It is a fracture of the distal 1/3rd of the radius with dislocation or subluxation of the inferior radioulnar joint. It is due to rotational force causing swelling of the lower forearm; prominent head of ulna; and ulnar nerve injury. Like Montegia fracture if treated conservatively it will redisplaye This fracture appeared in acceptable Fracture redisplaced in POP. This required position after reduction and POP ORIF Galeazzi Fracture Both bone forearm fracture rehabilitation Phase I: (weeks 0–2) Patient is placed into a splint and surgical incisions are protected Sutures or staples are removed at week two. Elevation of extremity encouraged Edema control and ROM of fingers Phase II: (weeks 2–6) Active and active-assisted ROM of elbow, forearm, and wrist No repetitive forearm twisting Phase III: (weeks 6 and beyond) Lifting and twisting restrictions lifted once union has been Achieved Work on regaining preoperative motion if not already achieved. It is crucial to communicate with the treating surgeon regarding When union has been achieved and when restrictions may be removed or surgeon preference regarding weight lifting limits despite lack of full union.  Distal Radial Fractures Colle’s fracture Smith fracture Barton’s fracture= volar and dorsal Radial Styloid Fracture (Chauffeur Fracture).  Colle’s fracture Extra-Articular: The major fracture line runs transversely across the distal radius, usually about 2 cm proximal to the radiocarpal joint. This is one of the most common of all fractures. It affects primarily older people. Women are afflicted more often than men because of the prevalence of osteoporosis, especially in older women. It results from a fall on dorsi flexed (extended) wrist, typical deformity: Dinner Fork The momentum of the body weight causes the distal fragment to displace radially and rotate in a supinatory direction with respect to the proximal bone end. The momentum that results in radial displacement may also cause a sprain of the ulnar collateral ligament and an avulsion fracture of the ulnar styloid process. Because this metaphyseal area of bone is typically osteoporotic, the compression force often results in comminution and impaction of the distal fragment.  Complications Complications of Colles fracture: Early complications of Colles fracture are Radial artery injury Carpal tunnel syndrome Extensor pollicis longus injury Late complications of Colles fracture are Malunion Joint stiffness Volkman ischemic contracture Osteoarthritis Sudeck's osteodystrophy (CRPS: Complex regional pain syndrome) Malunion: A Colles' fracture rarely heals without some residual malalignment. The radius invariably ends up foreshortened such that the radial styloid process no longer extends beyond the ulnar styloid process. The distal end of the radius also tends to be angulated and displaced dorsally. The malalignment described above will result in a permanent loss of full wrist flexion and ulnar deviation. In addition, there may be some residual mal alignment of the distal fragment toward supination, resulting in a loss of pronation. The distal fragment may also heal when displaced radially, but this would have little effect on motion.  Reflex sympathetic dystrophy syndrome (Sudecks atrophy) Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. Complex regional pain syndrome (CRPS) typically develops after an injury, a surgery, a stroke or a heart attack. The pain is out of proportion to the severity of the initial injury. Type 1 complex regional pain syndrome (CRPS 1), formerly known as reflex sympathetic dystrophy (RSD), it is a clinical syndrome of variable course and unknown cause characterized by pain, swelling, and vasomotor dysfunction of an extremity. CRPS 1 may also develop in the absence of an identifiable precipitating event. the patho-physiology of RSDS is not well understood. It has been postulated that both peripheral and central mechanisms may lead to sympathetic dysfunction. Its clinical symptoms are intense prolonged pain, pitting edema, tenderness, change skin color with shiny discoloration, vasomotor dysfunction of the extremity and restricted movements. Treatment of the patients depends on early recognition, early intervention of physical therapy besides the anti-inflammatory agents and nerve blocks. The physical therapy for CRPS: concentrate on pain and edema control, TENS ,active exercises of upper limb, auto passive exercises to regain the normal range, weight bearing exercises, and functional activities of upper limb as well and aquatic therapy, mirror therapy ,desensitization. Mirror therapy or mirror visual feedback, mirror therapy is where both hands are placed into a box with a mirror separating the two compartments and, whilst moving both hands, the patient watches the reflection of the unaffected hand in the mirror. Desensitization consist of giving stimuli of different fabrics, different pressures (light or deep), vibration, tapping, heat or cold.  Treatment An undisplaced fracture may be treated with a cast alone. The cast is applied with the distal fragment in slight palmar flexion and ulnar deviation which called colles cast. A fracture with mild angulation and displacement may require closed reduction. Significant angulation and deformity may require an open reduction and internal fixation or external fixation.  Physical therapy guide One of the primary focuses in early rehab is to limit pain and the amount of edema present in the wrist and hand region. Emphasize motion at the shoulder, elbow, and fingers during all phases of rehab. The focus in the beginning of rehabilitation is to mobilize the wrist, which is indicated approximately 7-8 weeks post fracture. If the fracture is managed using an internal fixation device, early mobilization can begin approximately 1 week after surgery. Regain range of motion (ROM) at the wrist with passive ROM and progressing to active ROM. Active and active assisted wrist exercises as much as range as possible specially extension and radial deviation. In the next phase of rehabilitation to focus on increasing ROM and beginning strengthening exercises. For surgically treated wrist, the majority of ROM should be regained between 6 to 8 weeks post-op. During this phase, progressive stretching can begin to increase available ROM. The two most common stretches are bringing the wrist into extension or flexion. If the patient is unable to tolerate a slow, prolonged stretch, shorter stretches of 10 seconds are performed for 10 repetitions.  Smith Fracture Smith fracture also called reserved colles fracture or a Goyrand fracture. in which transverse fracture occurs at the lower end of radius 2.5 cm proximal of the articular surface with anterior displacement of distal fragment of radius (Palmar displacement). Almost the opposite of Colles’ fracture, Much less common compared to colles’.Results from a fall on palmer flexed wrist. Typical deformity: Garden Spade. Management is the same as in colles EXCEPT we concentrated on regaining of wrist flexion ROM Colle’s versus smith’s fr  Barton’s Fracture Dislocation It is Intra-Articular distal radius fracture with volar displacement which looks like smith fracture. There is dorsal type which looks like Colles’ fracture. Management is by ORIF. ORIF Volar Barton’s  Radial Styloid Fracture Radial Styloid Fracture (Chauffeur Fracture). Mechanism of injury is compression of the scaphoid against the styloid. Treated by Non-displaced: Cast immobilization Displaced: Surgical fixation