UPPER LIMB FRACTURES PART 2

CONTENT

• FRACTURE OF THE FOREARM BONES

• MONTEGGIA FRACTURE
• GALEAZZI FRACTURE
• COLLES FRACTURE
• SMITH FRACTURE
• BARTON FRACTURE
 FRACTURE OF RADIUS ULNA

Conservative
•In children, closed treatment is usually successful
because the tough periosteum tends to guide and
then control
•Above elbow cast extending to metacarpal shaft

Operative
Mechanism of injury: •Open Reduction and internal fixation (ORIF)
twisting force – spiral fracture
direct force – transverse fracture

 Easily displaced, bleeding and swelling

 Complications

EARLY COMPLICATION
COMPARTMENT SYNDROME-From the fracture or post operative
NERVE INJURY-Posterior interosseous nerve(finger drop)
VASCULAR INJURY-Radial and ulna artery

LATE COMPLICATION
DELAYED UNION AND NON UNION
MALUNION (synostosis)
 MU

Fracture proximal
1/3 Ulna with
dislocation of
radial head

 Mechanism of injury:
Fall on hand, arm in hyperextension, causing ulnar
fracture bow forward and radial head dislocate
forward
 Fracture distal
GR
third of Radius
with Radioulnar
joint disclocation

Piano key- sign

 Colle’s
fracture Displacement
Extra articular, occurs Dorsal tilt
more in osteoporotic Dorsal
elderly female displacement
Distal End Radius Lateral tilt
fracture at level of cortico- Lateral
cancellous junction. displacement
Distal fragment displaced
DORSALLY
Mechanism: Fall on
outstretched hand,
dorsiflexed hand
Treatment:
CMR + full length cast
Buttress/locking plate
Smith fracture
Reversed Colle’s
Distal End Radius
fracture with distal
fragment displaced
VOLARLY
‘Garden spade’
deformity
Treatment = Reduced
by traction, supination,
extension
= Cast 6w
Colles’s VS
Smith
 BARTON’s Fracture
Intra-articular fracture of distal radius with dislocation of the
radiocarpal joint
 Internal fixation
( buttress plate)

 CMR + cast for 6w

Complication:
Chronic carpal
instability
Secondary OA
HANDS
Scaphoid fracture
oMechanism of injury : fall
on dorsiflexed hand
oCF: Tenderness and fullness
over anatomical snuffbox
oTreatment: glass holding
cast / ORIF
Complication:
 AVN of the proximal
fragment
 Non-union
 Secondary OA
 SNAC
Scaphoid non-union
advanced collapse
Spilled tea cup sign  Scaphoid fracture often
associated with perilunar
dislocation (scapholunate
ligament disruption)
 Symptoms: acute wrist
swelling and pain
 Treat by:
closed reduction/splinting
followed by open
reduction, ligament repair,
fixation, possible carpal
tunnel release
Boxer’s fracture: Bennett’s fracture
fracture of the head of
4TH OR 5TH metacarpal
bone(extra-articular)
Treatment:
splinting/cast
- is a intra-articular
fracture of the base of the
first metacarpal bone
which extends into the
carpometacarpal
(CMC) joint.
- Thumb subluxated
proximally, pulled by APL
Tx: K-wire / Lag screw
Rolando
Intra-articular
comminuted
fracture of the
base of first
metacarpal bone
Treatment: Closed
reduction + K-wire
ORIF
T type Y type
Metacarpal fracture
• Can be divided into metacarpal head, neck,
shaft
• Mechanism of injury : direct blow to hand/
rotational injury
• Managed by :
- immobilization
- open reduction
internal fixation
• Assure all fingers
point to scaphoid
area when flexed
at PIPs  CASCADE SIGN
Thank you.