FRACTURE RADIUS AND

ULNA
Dr. Dewi Kurniati, M.Kes., SpOT
Special anatomy—the two bones of the
forearm function as a joint
Articulations
Six Joints

Ulna-humeral

Radial-capitellar

Proximal radial-ulnar

Distal radial ulnar

Radial carpal

Interosseous membrane
Forearm Anatomy
Consequences of deformity
Shortening
Angulation
Loss of radial bow
Loss of alignment
◦ loss of motion
◦ loss of function
Forearm Fractures
Epidemiology
◦ Highest ratio of open to closed than any other fracture except the tibia
◦ More common in males than females, most likely secondary mva, contact
sports, altercations, and falls

Mechanism of Injury
◦ Commonly associated with mva, direct trauma missile projectiles, and falls
Forearm Fractures
Clinical Evaluation
◦ Patients typically present with gross deformity of the forearm
and with pain, swelling, and loss of function at the hand
◦ Careful exam is essential, with specific assessment of radial,
ulnar, and median nerves and radial and ulnar pulses
◦ Tense compartments, unremitting pain, and pain with passive
motion should raise suspicion for compartment syndrome
Radiographic Evaluation
◦ AP and lateral radiographs of the forearm
◦ Don’t forget to examine and x-ray the elbow and wrist
Investigations
X-ray in two planes—must include
both joints

CT—rarely indicated

MRI—useful for assessing damage to

articular cartilage of distal radioulnar
joint

Angiography—vital in cases involving

vascular trauma
Fracture with joint disruption
Monteggia fractures
Ulnar shaft fracture with
◦ Dislocation of radial head
◦ Types I – IV depending on direction of radial head dislocation
 Imaging
Radiographs
◦ recommended view
◦ AP and Lateral of elbow,
wrist, and forearm

CT scan
◦ helpful in fractures involving
coronoid, olecranon, and
radial head

Source : https://www.orthobullets.com/trauma/1024/monteggia-fractures
Fracture with joint disruption
Galeazzi fractures
Radial shaft fracture with:
◦ Dislocation of distal ulna
◦ Multiple variants in location of
radius fracture
 Imaging
Radiographs
◦ recommended views
◦ AP and lateral views of forearm, elbow, and wrist
◦ findings
◦ signs of DRUJ injury
◦ ulnar styloid fx
◦ widening of joint on AP view
◦ dorsal or volar displacement on lateral view
◦ radial shortening (≥5mm)

Source : https://www.orthobullets.com/trauma/1029/galeazzi-fractures
Personality of fracture
Soft-tissue damage

Degree of fracture displacement

Degree of comminution

Degree of joint involvement

Osteoporosis

Nerve/blood vessel injury

Goals of treatment
Anatomical reduction

Restore ulnar & radial length

Reduce/stabilize joints

Restore rotational alignment

Repair soft-tissue injuries

Restore normal function

Goals of treatment
Reduction Principles
◦ Articular

Fixation Principles
◦ Diaphyseal
Evaluation
Usually high-energy (associated trauma)
Elbow (radial head)
Wrist (DRUJ)
Neurological
Vascular
Integument
Swelling
Indications for operative
treatment
Combined fractures of ulna and radius

Displaced isolated fracture of either bone

Monteggia and Galeazzi

Every open fracture

Plate fixation
The “Gold Standard” treatment for most diaphyseal forearm fractures
Stable, strong, anatomical fixation
Union rates > 95%
Timing of surgery
Splint application with elective scheduling for
uncomplicated closed fractures

Immediate fixation for:

◦ Open fractures
◦ Impending open fractures
◦ Compartment syndrome
◦ Unreducable dislocations

Easier fracture reduction with early surgery,

especially if shortening is present
Postoperative care
Avoid prolonged immobilization

If you fix it internally, do not fix it externally

Immobilize the minimum time needed to protect the soft tissues

Dislocations may require immobilization

Begin early active ROM

Problems
Soft-tissue loss

Infection

Synostosis 2,6–6,6%

Nonunion 3,7–10,3%

Refracture after implant removal up to 25%

THANK YOU