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Orthopaedics

Fractures of the Ulnar and Radial Shaft

Built from Tang — Orthopaedic Trauma Vol 1: Upper Extremity

What’s inside

11 sections · 102 slides

  1. 01

    Overview

    • What this topic teaches you

    1 slide

  2. 02

    The forearm as a rotating unit

    • The big picture: why forearm fractures are special
    • The forearm treated as an intra-articular fracture
    • The goals of treatment, stated plainly

    3 slides

  3. 03

    Applied anatomy of forearm rotation

    • How much the forearm rotates, and how much you need
    • Normal and functional range of forearm rotation
    • The shapes of the two bones
    • The radial arch: measuring the curve you must rebuild
    • Measuring the maximum arc of the radius
    • The proximal radioulnar joint: two key ligaments
    • Ligaments of the proximal radioulnar joint
    • The interosseous membrane: the forearm's load bridge
    • Axial load sharing through the interosseous membrane
    • The oblique cord and the neutral fixation position
    • The distal radioulnar joint and the TFCC
    • The triangular fibrocartilage complex of the wrist
    • How the TFCC fibres keep the wrist stable
    • Radius fractures often injure the distal joint
    • The crankshaft radius and the rotation muscles
    • Crankshaft radius and muscle-driven displacement
    • Fracture site predicts the displacement
    • The axis of forearm rotation
    • The conical axis of forearm rotation
    • Why radial length must be restored exactly
    • The Henry muscle group: your window to the radius
    • The Henry muscle group of the radial forearm
    • The arcade of Frohse: protecting the deep radial nerve
    • Arcade of Frohse and the deep radial nerve

    24 slides

  4. 04

    How these fractures happen

    • Direct violence: a blow straight to the bone
    • Indirect violence: force travelling up the arm
    • Mechanism of a Galeazzi fracture from a fall

    3 slides

  5. 05

    Classifying the fractures

    • The AO/OTA classification: three families
    • AO Type A: simple forearm fractures
    • AO Type B: wedge forearm fractures
    • AO Type C: complex forearm fractures
    • Monteggia fracture: the Bado classification
    • Bado classification of Monteggia fractures
    • Reading Monteggia types and Jupiter subtypes
    • Galeazzi fracture: radius break plus joint injury

    8 slides

  6. 06

    Assessing the injured forearm

    • Clinical assessment, and the emergency not to miss
    • Imaging: never image the forearm alone
    • Full-length forearm imaging including wrist and elbow
    • Signs of distal joint injury, and the role of CT

    4 slides

  7. 07

    Surgical indications and aims

    • Who needs surgery, and what surgery must achieve

    1 slide

  8. 08

    Surgical approaches to the forearm

    • Choosing the right approach for the injury
    • Positioning and preparation
    • Limb positioning for forearm surgery
    • Planning the incisions on the skin
    • Surface marking of the three forearm approaches
    • The dorsal Thompson approach, step by step
    • Dorsal Thompson approach to the radius
    • The palmar Henry approach: superficial dissection
    • Henry approach: superficial exposure of the radius
    • The Henry approach: exposing each third of the radius
    • Henry approach: level-by-level radius exposure
    • The ulnar approach
    • Direct dorsal approach to the ulnar shaft

    13 slides

  9. 09

    Reduction and internal fixation

    • Monteggia: reduce the ulna first
    • Monteggia: ulnar reduction relocates the radial head
    • Confirming and salvaging the radial head
    • Proximal ulnar fracture with radial head dislocation
    • Galeazzi: reduce the radius first and rebuild the arch
    • Pre-shaped anatomical locking plates for the radius
    • Galeazzi: check the distal joint, always
    • Galeazzi fracture fixed with distal joint checked
    • Managing an unstable distal radioulnar joint
    • Double fractures: the order of fixation
    • Both-bone forearm fracture fixed through two incisions
    • Requirements for the final fixation
    • Both-bone fracture fixed: reduction and compression
    • When plate plus intramedullary fixation helps
    • Combining plate fixation with intramedullary nailing
    • Segmental forearm fracture: plate and elastic wire
    • Postoperative treatment and rehabilitation

    17 slides

  10. 10

    Complications and prevention

    • Instability of the radioulnar joints
    • Failed Monteggia fixation: radial head left dislocated
    • A cautionary tale: never simply remove the radial head
    • Elbow instability after radial head removal
    • Nonunion and malunion: use anti-rotation plates
    • Insufficient fixation strength leading to failure
    • Cross-union (radioulnar synostosis) and its causes
    • Radioulnar cross-union impairing forearm rotation
    • Preventing cross-union

    9 slides

  11. 11

    Bringing it together

    • Three principles to remember
    • Final takeaways
    • References (1/5)
    • References (2/5)
    • References (3/5)
    • References (4/5)
    • References (5/5)
    • Orthopaedic Trauma Surgery — Volume 1: Upper Extremity

    8 slides