Forearm Fractures and Treatment Overview

Introduction to Forearm Anatomy

The forearm consists of two primary bones: the radius and the ulna. The radius articulates with the carpal bones at the wrist, while the ulna connects with the humerus at the elbow joint. The ulna is generally static, whereas the radius rotates around the ulna, facilitating pronation and supination of the forearm. The triangular fibrocartilage complex (TFCC) plays a crucial role in stabilizing the distal radioulnar joint (DRUJ).

Types of Forearm Fractures

Both Bone Fracture

Both bone fractures involve the breaking of both the radius and ulna. Treatment options include closed reduction (CR) with plaster of Paris (POP) or open reduction (OR) with internal fixation (IF) using plates and screws, which is often considered the best approach.

Monteggia Fracture

A Monteggia fracture is characterized by a fracture of the upper third of the ulna, often referred to as a fracture of necessity, accompanied by a proximal radioulnar joint (RUJ) disruption and radial head dislocation. Treatment typically involves open reduction and internal fixation (ORIF) with plates and screws.

BADO Classification

The BADO classification system categorizes Monteggia fractures into four types based on the direction of radial head dislocation:

  • Type I: Anterior dislocation
  • Type II: Posterior dislocation
  • Type III: Lateral dislocation
  • Type IV: Anterior dislocation with fracture of the radius

Treatment and Complications

Treatment for Monteggia fractures often involves open reduction and internal fixation (ORIF) with plates on the ulna and screws, sometimes using K-wires to stabilize the proximal radioulnar joint (PRUJ). Complications can include injury to the posterior interosseous nerve, a branch of the radial nerve, which can cause finger and thumb drop without sensory deficit.

Common Nerve Injuries

In shoulder dislocations, the axillary nerve is most commonly injured. In supracondylar humerus fractures, the anterior interosseous nerve, a branch of the median nerve, is often affected.

Conclusion

Understanding the anatomy and classification of forearm fractures is essential for effective treatment and management. Proper diagnosis and treatment planning can help prevent complications and ensure optimal recovery.

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