Fractures of the bones of the forearm: causes, symptoms, diagnosis, treatment

ICD-10 code

• S52.0. Fracture of the upper end of the ulna.
• S53.0. Dislocation of the head of the radius.
• S52.5. Fracture of the lower end of the radius.

Classification of fracture of forearm bones

There are two types of fracture of the forearm bones: Monteja and Galeazzi. In the first case, a fracture of the ulna in the upper third occurs with a dislocation of the head of the radius. In the second case, fracture of the radius in the lower third with dislocation of the ulnar bone head.

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Fractured Monteja

ICD-10 code

• S52.0. Fracture of the upper end of the ulna.
• S53.0. Dislocation of the head of the radius.

Classification

There are bending and extensor type of damage.

Causes

The extensor type occurs when the upper third forearm is dropped and hit against a solid object or when it strikes this area. There is a fracture of the ulnar bone, and the continuation of violence leads to rupture of the annular ligament and dislocation of the head of the radius.

The flexural type of damage occurs when the load is applied mainly to the distal forearm and directed from the rear to the palmar side and along the longitudinal axis of the forearm. There is a fracture of the ulnar bone in the middle third with a displacement of the fragments at an angle open in the palmar side, and a dislocation of the head of the radius in the back.

Symptoms and Diagnosis

Extensor type. Pain in the fracture site and a sharp disruption of the function of the elbow joint. The forearm is somewhat shortened, edematous in the upper third and in the region of the elbow joint. Movement in the elbow joint is severely limited, when trying to move - the pain and sensation of an obstacle in the anterior anterior surface of the joint. Palpation in this zone shows protrusion. When you feel the crest of the ulnar bone at the site of the injury, determine soreness, deformation, pathological mobility and crepitation are possible. On the roentgenogram, a dislocation of the radius head is detected anteriorly, a fracture of the ulnar bone at the border of the upper and middle thirds with an angular displacement. The angle is open to the rear.

Flexion type. The violation of the relationship between the bones and determines the clinical picture of the damage: pain in the fracture and elbow joint, which is deformed due to edema and protruding posterior to the head of the radius, moderate limitation of functions due to pain, shortening of the forearm. X-ray picture confirms the diagnosis.

Treatment

Conservative treatment

Conservative treatment consists of repositioning the fragments and eliminating the dislocation. Manipulation is performed under local anesthesia or general anesthesia by hand or with devices for repositioning the bones of the forearm.

• With an extensor type, traction is applied to the wrist of the forearm bent at right angles and the supine forearm, and the fragments of the ulna are compared. If the reposition was successful, then the ray in many cases is reset independently. If this does not happen, the dislocation is removed by applying pressure to the radial head and displacing it posteriorly.
• In the flexion type, traction is also applied to the brush of the supine, but unbent, forearm. Pushing the fingers from the rear to the palm surface of the forearm, the surgeon compares the fragments. Further manipulations are the same as for the extensor type of damage.

At the end of the manual, a circular gypsum bandage is applied from the upper third of the shoulder to the heads of metacarpals when flexing at the elbow joint at an angle of 90 °, supination of the forearm and a functionally advantageous position of the hand for 6-8 weeks. Then they start restorative treatment, keeping the removable longure for another 4-6 weeks.

Surgery

Operative treatment is used in case of failure of closed manipulations. The most common cause of unsuccessful attempts to reposition and eliminate dislocation is the interposition - the introduction of soft tissues between fragments or between articulating surfaces.

The operation consists in removing the interponate, directing the head of the radial bone and intraosseous metalloesteosynthesis using the retrograde method of the ulna. For the prevention of repeated dislocations, the auto-fascia of the annular ligament is sewed or performed with plastic. Sometimes, in order to prevent the relaxation, the Kirschner's needle is guided through the brachium joint, it is extracted in 2-3 weeks. Another way to hold the head is to pin it with a short spike to the coronoid process.

After the operation, the limb is fixed with a plaster bandage from the upper third of the shoulder to the metacarpophalangeal joints for 6 weeks, then it is converted into a removable one and stored for another 4-6 weeks.

In the old cases of fracture of the Monteja, osteosynthesis of the ulnar and resection of the head of the radius are performed.

Estimated period of incapacity for work

After conservative treatment, labor is possible in 12-16 weeks. After surgical treatment, recovery is through 12-14 weeks.

Fractured Galeazzi

ICD-10 code

S52.5. Fracture of the lower end of the radius.

Classification

The mechanism of trauma and displacement of fragments distinguish the extensor and flexion types of damage.

• In the extensor type, the fragments of the radius are displaced at a corner open in the back side, and dislocation of the ulna head occurs in the palmar side.
• For the flexural type of damage, displacement of fragments of the radial bone at an angle open in the palmar side is characteristic, and the ulnar bone head is displaced to the rear.

Causes

Fracture Galeazzi is possible from a direct and indirect injury mechanism, as a result of fracture of the radius in the lower third and dislocation of the ulnar head.

Symptoms and Diagnosis

The diagnosis is based on the mechanism of trauma, pain and disturbance of the functions of the wrist joint, angular deformation of the radial bone, tenderness in palpation. The head of the ulna extends to the outside and to the rear or palm side, is movable. The movements of her are painful. The radiograph confirms the diagnosis and helps determine the type of damage.

Treatment

Treatment can be conservative and operative.

Conservative treatment

Conservative treatment begins with sufficient anesthesia in one of the ways. Then, a manual or hardware repositioning of the fracture of the radial bone is performed by traction for the wrist in the middle between supination and pronation of the position of the forearm. Displace the width and angle of the surgeon eliminates the hands. It is also easy to fix the ulnar head. The difficulty lies in the fact that it is not always possible to hold the ulna in the corrected position. If this is still possible, then the pelota is placed in the area of the ulna head, and the limb is fixed with a plaster cast from the upper third of the shoulder to the base of the fingers for 6-8 weeks, and then for active physiotherapeutic treatment immobilization is converted into removable and stored for another 4-6 ned.

Surgery

If conservative measures do not succeed, they switch to surgical treatment. Begin with stable osteosynthesis of the radial bone with an intramedullary pin or plate. To keep the head of the ulna, various methods are used: the plastic of the radio-ligament ligament, the fixation with its Kirschner's needle, the fixation of the radial and simultaneously ulnar bones with their convergence in Ilizarov's apparatus. Some authors advise in difficult cases to resect the head.

The volume and timing of immobilization are the same as for conservative treatment.

It should be remembered that the treatment of fractures always begins with the elimination of dislocation, and then produces a reposition of the fragments. This rule is. Treatment of the same damages of Monteja and Galeazzi serve as an exception when the reposition is performed first and only then the dislocation is eliminated.

There are two more types of fractures, described in the literature, but never met before. This fractured malgens (fracture of the elbow and coronary processes and forearm forearm dislocation anteriorly) and fractured Essex-Lopresti - dislocation of the head of the radial bone (sometimes with a fracture), dislocation of the ulnar bone head, rupture of the interosseous membrane and displacement of the radial bone proximally. Both fractures are treated promptly.

Estimated period of incapacity for work

The ability to work is restored in 11-13 weeks.