Transcript Presentation1.pptx

Radius and ulna Fractures
including Monteggia and Galeazzi
FX. DX.
By: M.H. Nouraei M.D.
Isfahan University of medical sciences
Introduction:
The forearm plays an important role in
positioning of the hand in space by flexion
and extension of the elbow and wrist as
well as pronation and suspiration through
the proximal and distal radioulnar joints.
Fractures of the ulnar and radial shaft can
therefore results in significant dysfunction
if treated inadequately.
The incidence of distal radius fractures has increase over
the past decades. However, the frequency of foream shaft
fractures appears to be stable over time. The average
yearly incidence inadults has been reported to be 1.35 per
10.000 population ranging form 0 to 4 per 10.000
population depending in age and gender. This is relatively
infrequent compared to that of humerus shaft(0 to 10),
femur (0 to 37). And tibia (0 to 21). Four- fifths of forearm
shaft fractures occur in children. Above the age of 20 the
rearly incidence of forearm shaft fractures remains below
2 per 10.000 people, predominating in males throughout
all age groups.
Mechanism of injury:
High energy trauma
Direct and indirect
Seqmental FX.
Direct
Trauma
Isolated ulnar FX.
Gunshot froctures
Indirect Trauma:
Bending forces can result to monteggia
Tortional forces+
Axial loading ie(falling)
(hyper pronation)
Can lead to both bones fr(luterasseous
membrance reoture) and TFCC(Triangular
fibro cartilage complex)
Monteggia with
posterior dislocation
of radial head
Hyper supination
forces
Monteggia with
anterior dislocation
of radial head
Hyper pronation
forces with
outstretched hand
Associated injuries:
One third (1/3) of forearm shaft fractures are isolated
Two third (2/3) are with at least one associated
inhuries
• Those are adjacent to forearm
• Those are other sites of muscle skeletal system
• Those are other organ systems
• Open fractures – Neurovascular– Injuries
Classification: -Bado
-Open Fractures
Gustillo
- AO/OTH classification: identified with Number
22(2 for foream-2 for shaft)
Type A: simple fractures
Type B: wedge fractures
Type C: complex fractures (comminuted or
segmented )
Pathoanatomy and applied anatomy:
-Osseous plane
- Radius: in adults measures average 25 cm
The nutrient artery of radius enters on the volar
aspeet at average 9cm distal to radial head.(6-12 cm)
Cancellors bone 4cm in proximal and 5 an in distal
radius.
Isthmus of endomeduldary canal is in mid point of
radius.
Ulna: is the axis around which the radius
rotates during supination and pronation
-Greater sigmoid notch
-Lesser sigmoid notch
-F.C.U. and E.C.U
-TFCC
Interosseous space: oval in shape
-Greater distance Is in supination.
-Interosseous membrane: anterior and
posterior compartment
-Interosseous ligament or central band:
20 degree obliquely and is constrain
against radial shortening and after
Radial head Resection.
Triangular fibrocartilage complex (TFCC)
Serves as the medial continuation of the distal
articular surface of the radius as well as static
stabilizer of the distal radio ulnar joint.
-Articular disc
-Dorsal radioulnar ligament(DRUL)
-Palmar radioulnar ligament(PRUL)
-Meniscus homologue
-Ulnar collateral ligament
-Sheath of the ECU
DRUL. And PRUL, are the primary
stabilizers of DRUJ and originates from
dorsal and palmar aspect of sigmoid notch
Summary, controversies, and future
O.R.I.F With
nonlocking
plate and screws
High rate of union
and satisfactory
function
Locking plate and
intramedullary
nailing
No advantage