Proximal Third Frx

above insertion of pronator teres.

 proximal fragment of radius is
supinated & flexed because of
unopposed action of biceps brachii
& supinator, and
 the distal fragment is pronated by the
action of the pronator teres &
pronator quadratus muscles.
 to obtain alignment of the fracture,
the distal fragment should be
supinated;
Middle Third Fractures

below pronator teres

 proximal fragment is held in neutral rotation,
as action of supinator is countered by the
pronator teres.
 proximal fragment is drawn into flexion by
action of biceps.
 distal fragment is pronated & drawn toward
ulna by pronator quadratus.
 to achieve anatomic reduction, distal fragment
is brought into neutral rotation
Distal Third Fractures

below pronator teres

 distal fragment of the pulled radius
is pronated & pulled inward by
pronator quadratus.
 overriding & shortening are caused
by obliquity of frx & pull of muscles.
Pediatric Both Bone Forearm Fractures
 frx may be greenstick or complete in both the
radius and ulna.
 mechanism:
- indirect injury during fall on an outstretched
hand;
- direct violence occassionally is cause of both
bone forearm.

 in pts < 6 yrs of age:
- upto 15 deg of angulation is acceptable, especially if frx is distal;
- 5 deg of rotation may also be acceptable;
- between ages of 6-10 yrs:
- less than 10 deg of angulation should remodel especially if frx is
close to distal epiphysis;
- bayonet apposition may be acceptable, although end to end
apposition is preferred;
- acceptable angulation is less than 15 deg, however, even more
angulation
may be preferable to resorting to open reduction;
- this is especially true if the reduction allows physiologic
pronation and supination;
- pts > 12 yrs of age:
- no angulatory or rotational deformity is considered acceptable;
- more aggressive treatment is required, including open reduction and
compression plating may be required;
- Displaced Distal Third Frx:
- angulation up to 20-25 deg during first ten years is OK;
- angulation > 10 deg is unlikely to correct after 10 yrs;