Forearm and Wrist

Fractures
By Dr Fiona Hill
HMO2
Key Learning Points
1. www.eorif.com

2. Always XR the joint above and below #.

3. # Ulnar = check the radial head

# Radius= check the druj

4. GFR: Galeazzi = Fractured Radius

BUM: Broken Ulnar = Monteggia

5. www.imagingpathways.health.wa.gov.au
Summary of Fractures
Galeazzi
Monteggia
Isolated Forearm
Fractures
Colles Fracture
Smiths Fracture
Fracture of Radial
Styloid
Forearm Fractures 101
Radius and ulnar are bound together by:
Annular ligament
Interosseus membrane
Radioulnar ligaments and triagular fibrocartilage.

With a direct blow you can break either

isolated, however more likely w/ indirect
(i.e. FOOSH) to damage both.
www.imagingpathways.health.wa.gov.au
www.imagingpathways.health.wa.gov.au
Galeazzi
GFR: Galeazzi Fractured Radius

Definition: Fracture of the radial shaft

(usually distal 1/3) with dislocation of
the distal radioulnar joint

Clinically: Pain and swelling in

forearm and wrist. Forearm rotation
very painful.
NV exam, evaluate for compartment
syndrome, evaluate soft-tissue
envelope, wrist evaluation.
Galeazzi part 2
Radiologically: A/P and Lateral of
forearm +/- elbow, wrist.

Mx: ORIF of the radius is indicated in

all cases.
Further Mx depending on stability of
distal radioulnar joint.

Assoicated injuries/DDx:
Ulnar Styloid Fracture
TFCC Tear
DRUJ Instability
Monteggia
BUM: Broken Ulnar Monteggia
# ulna with dislocation of the
radial head.
1in14 of forearm #
More common in children.
Adult injuries are typically high
energy, fall from heights or MVA.

Clinical Evaluation: Pain and

swelling in the elbow and ulnar
border of the forearm. ROM
limited by pain.
NV exam, evaluate for
compartment syndrome,
evaluate soft-tissue envelope,
wrist evaluation.
Monteggia
Radiology: A/P and Lateral of
forearm +/- elbow, wrist.
Always suspect a radial head
dislocation in an ulnar #.

A line drawn along the axis

of the radius should pass
through the capitellus on
both lateral + AP views.

MX: ORIF generally.

Isolated Ulnar/Radius
Most fractures of the
ulnar/radius shaft are
caused by direct blows and
result in minimal soft-tissue
injury.

Generally obvious gross

deformity
NV exam, evaluate for
compartment syndrome,
evaluate soft-tissue
envelope, wrist evaluation.

A/P and Lateral of forearm

+/- elbow, wrist.
Isolated Ulnar/Radius
Ulnar Shaft Fracture Associated Injuries /
Differential Diagnosis
Monteggia fracture-dislocation.
Radius and ulna shaft fracture.
Galeazzi Fracture

Mx:
Depends on if its a distal, middle or proximal third.
Plus if its displaced or not.
Can be conservative or ORIF.

Fracture Complications
a
Superficial wound infection
Nonunion: (incidence is higher for comminuted or
displaced fx's)
Hardware failure
Malunion
Painful hardware
Ulnar nerve palsy
Radial nerve palsy
Distal Radial Fracture (+ Colles
Fracture)
Most commonly women age 60-70.
90% caused by compression on dorsiflexed
wrist.
90% of distal radius fractures are Colles
Fractures
Colles Fracture
Definition: Dorsally displaced fracture of
the distal radius generally occuring 2-3 cm
proximal to the radiocarpal joint.

Most common #, seen mainly in middle

aged and elderly women.

FOOSH most likely cause.

Clinical Evaluation: Pain and swelling in

wrist, often gross deformity in wrist.
NV exam, evaluate for compartment syndrome,
evaluate soft-tissue envelope
Evaluated for carpal tunnel syndrome
Evauate for possible scaphoid injury.

Deformities include: occurs through

metaphysis, dorsal displacemnt of the
distal fragment, anterior angular of distal
fragment, impaction between the distal
fragment and the shaft. There is lateral
displacement of the distal fragment.
Colles Fracture
XRs: Forearm XR AP/Lat + wrist PA/lat +/- elbow AP/Lat.

Mx: Can be generally managed with closed reduction

with well molded cast/splint.
Significant angulation and deformity may require an open
reduction and internal fixation.
An open fracture will always require surgical intervention.

Consider Osteoporosis evaluation and management.

Complications of Colles/ DDx:

Galeazzi Fracture: highly associated with distal 1/3 radial
shaft fractures
Ulnar styloid fracture
DRUJ Instability
Compartment syndrome @1%
Median nerve injury
Tendon injury,attritional EPL rupture.
Scapholunate ligament tear.
TFCC injury, up to 50% when ulnar styloid fx also present
Carpal ligament injury.
Smiths Fracture
Definition: Distal radial fragment is tilted
into a posteior angulation and may be
displaced ventrally (volar). (Reverse
Colless)

Mechanism: Direct blow to the dorsal

forearm or falling onto flexed wrists,
(as opposed to a Colles' fracture = falling
onto wrists in extension.)
Smith's fractures are less common
than Colles' fractures.

Mx:
Undisplaced fracture = cast alone.
Mild angulation and displacement may
require closed reduction.
Significant angulation and deformity may
require an open reduction and internal
fixation.
An open fracture will always require surgical
intervention.

Consider Osteoporosis evaluation and

management
# Radial Styloid Fracture
Isolated radial styloid #.
Displacemnt is normally slight.

Mechanism: FOOSH or
kickback injury.

Mx:
Manipulation rarely of value.
If minimal displacement,
Colles type plaster.
If distal articular surface
involved may need fixation.
Sudecks atrophy (complex
regional pain syndrome) is a
common complication.
Key Learning Points
1. www.eorif.com

2. Always XR the joint above and below #.

3. # Ulnar = check the radial head

# Radius= check the druj

4. GFR: Galeazzi = Fractured Radius

BUM: Broken Ulnar = Monteggia

5. www.imagingpathways.health.wa.gov.au
Thank you!