CHAPTER I

INTRODUCTION

A. Background

Bone fractures are commonly encountered in today’s industrial era. Various

treatment modalities were introduced from time to time and each of them had some edge over

the previous one. Fractures of the forearm bones may result in severe loss of function unless

adequately treated. Excellent results for plate fixation in displaced diaphyseal fractures of both

the radius and ulna have been reported by various authors, but only a few authors have

focused on plate fixation in the management of open diaphyseal fractures of both the radius

and ulna [1-10]. Diaphyseal fractures of the radius and ulna present specific problems in

addition to the problems common to all fractures of the shafts of long bones. In addition to

regaining length, apposition, and axial alignment, achieving normal rotational alignment is

necessary if a good range of pronation and supination is to be restored.

Because of these factors, open reduction and internal fixation for displaced

diaphyseal fractures in the adult are generally accepted as the best method of treatment, even

though closed reduction may be achieved. The muscle mass in the proximal forearm makes

maintenance of closed reduction difficult. Fractures of the distal radius tend to angulate toward

the ulna by the action of the pronator quadratus and the pull of the long forearm muscles.

Although union may be achieved by closed methods, if angular and rotary malalignments are not

completely corrected, some loss of function occurs and may make the overall result

unsatisfactory. The purpose of the study was to evaluate the effects of open reduction and
internal fixation with a dynamic compression plate (DCP) in diaphyseal fractures of both the

radius and ulna.

The interosseous membrane is an important structure that links the radius and

ulna, and most authors agree that its integrity is important for fracture stability. Hotchkiss and

coworkers

performed a biomechanical study on cadaveric specimens to determine its importance in

longitudinal forearm stability. A consistent central band of tissue was noted running ulnar-distal

to radial-proximal. This band provided 71% of the longitudinal stiffness of the forearm with the

radial head removed. Dymond and Ostermann and colleagues in two separate cadaveric studies

reported that a 50% displacement of the ulnar shaft correlated with an interosseous membrane

that was significantly disrupted. Both authors concluded that below-elbow immobilization was

appropriate for those fractures with evidence of an intact interosseous membrane. Muellner and

coworkers studied rotational instability in cadaveric middle third ulna fractures. They showed

that a transverse osteotomy was more stable than a cuneiform osteotomy, and that division of the

interosseous membrane increased rotational instability. Unlike previous studies, their specimens

rarely displaced greater than 50%, even with division of the interosseous membrane.

Isolated ulnar shaft fractures may be classified as stable or unstable. Unstable fracture are those

that have more than 50% displacement, more than 10_ angulation, involve the proximal third, or

have associated instability at the PRUJ or the distal radioulnar joint (DRUJ). An AO

classification for ulnar fractures exists; however, it is generalized to the forearm, is descriptive,

and does not assist in guiding treatment.

B. Problem

1. What is Fracture Ulnaris ?

2. How to know anatomy of Ulnaris ?

3. How the classification of Fracture Ulnaris ?

4. How to complications of Fracture Ulnaris ?

C. Purpose

1. To know Fracture Ulnaris

2. To know anatomy of Ulnaris

3. To know classification of Fracture Ulnaris

4. To Know complications of Fracture Ulnaris