Forearm traumatic injuries

Monteggia fracture

Fracture of the proximal or middle third of the ulna

with posterior dislocation of the radial head.
• Symptoms-pain and swelling at elbow joint.
• Typically, Monteggia fracture-dislocations occur as the result of
a fall onto an outstretched hand.
• Monteggia fractures occur mostly in children (peak incidence at
ages 4-10 years) and rarely in adult
• Diagnostic mainly by X-ray
• Ct-scan
• In the pediatric population, treatment depends on the type of
ulnar fracture: 7,8
• bowing/greenstick fracture: closed reduction of the ulnar bow
and casting. If reduction of the radial head is not possible open
osteotomy and fixation of the  ulna may be required. 
• complete transverse/short oblique fracture: closed reduction
and intramedullary fixation
• long oblique/comminuted fracture: open reduction and internal
fixation
 Galeazzi fracture
The Galeazzi fracture is a fracture of the middle to
distal one-third of the radius associated with
dislocation or subluxation of the distal radioulnar
joint.
Galeazzi fractures are primarily encountered in children,
with a peak incidence at age 9-12 years . In adults, it is
estimated to account for ~7% of forearm fractures.
Typically, Galeazzi fracture-dislocations occur due to a fall
on an outstretched hand  with the elbow in flexion.
Diagnostic:X-ray
• Treatment and prognosis
• These fractures are unstable and operative fixation is
usually required to reduce and fix the radial fracture,
with arm immobilization in pronation . The exact mode of
fixation depends on the location of the radial fracture : 
• diaphysis: elastic nail
• metaphyseal-diaphyseal junction: plate and screw
• distal radius: Kirschner wires (K-wires)
Distal radius fractures
Broken wrist
• A distal radius fracture almost always occurs about 1 inch from
the end of the bone. The break can occur in many different ways,
however.
• One of the most common distal radius fractures is a Colles
fracture, in which the broken fragment of the radius tilts upward.
This fracture was first described in 1814 by an Irish surgeon and
anatomist, Abraham Colles -- hence the name "Colles" fracture.
• Other ways the distal radius can break include:
• Intra-articular fracture. A fracture that extends into the wrist
joint. ("Articular" means "joint.")
• Extra-articular fracture. A fracture that does not extend into the
joint is called an extra-articular fracture.
• Open fracture. When a fractured bone breaks the skin, it is called
an open fracture. These types of fractures require immediate
medical attention because of the risk for infection.
• Comminuted fracture. When a bone is broken into more than two
pieces, it is called a comminuted fracture.
 accounts for 17.5% of all fractures in adults
younger patients due to high energy mechanisms
• older patients due to low energy mechanisms
• location
– intraarticular in 50%
• Symptoms are
– ecchymosis & swelling
– diffuse tenderness
– visible deformity if displaced
• motion
– limited by pain
Diagnostic
X-ray
 Treatment

Nonoperative  
• closed reduction and splint/cast
immobilization
• Almost all patients will have some stiffness in
the wrist. This will generally lessen in the
month or two after the cast is taken off or
after surgery, and continue to improve.