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Radial / Ulnar FracturesRadial head #MOI: FOOSH; most common # of elbow; often assoc inj (eg. Capitellum /olecranum / coronoid #, MCL inj, med epicondyle #)Classification: I Displaced <2mm; no mechanical block II Displaced <2mm; >30% radial head involvement; maybe mechanical block III Comminuted IV + dislocation Others: hairline, marginal, segmentalOE: localised tenderness over # site; incomplete elbow extension; pain on pronation / supinationMng: sling and mobilise; OT if >1/3 articular surface involved / >30deg angulation / >3mm depression / mechanical block / comminutedComplications: NV complications uncommonRadial neck #MOI: FOOSHOE: tenderness more distal; less painMng: sling if no angulation (up to 30deg allowed in children); manipulate if >20deg angulation with traction, supination and pronation; OT if gross displacement / epiphyseal injOlecranon #Intra-articular so require careful reductionClassification: I Displaced <2mm; trt conservatively II Displaced but ulnohumeral joint stable; needs OT III Displaced and unstableMid-shaft #’sOT if: displaced, unstable; >10deg angulation, or subluxation of prox / distal radioulnar jointNightstick #107950088900Midshaft ulna due to direct blow; needs POP 6-8/52; ORIF if >50% displaced or >10deg angulation or prox 1/3Midshaft ulna due to direct blow; needs POP 6-8/52; ORIF if >50% displaced or >10deg angulation or prox 1/3Monteggia #1079500146050Fracture prox 1/3 ulna with dislocated radial head (anteriorly in 60%)MOI: FOOSHComplications: interosseous and radial nerve inj; malunion and nonunion; unstable radial headMng: ORIF; can be managed closed in childrenFracture prox 1/3 ulna with dislocated radial head (anteriorly in 60%)MOI: FOOSHComplications: interosseous and radial nerve inj; malunion and nonunion; unstable radial headMng: ORIF; can be managed closed in childrenGaleazzi #1536700-1832610Reverse Monteggia; # midshaft or distal 1/3 radius with dsilcated distal radioulnar joint; 3x more common than MonteggiaMOI: FOOSHXR: radial styloid should project 8-18mm distal to radioulnar jt; distal radius should articular with at least ? lunate; ulna and radius should be meet to form smooth jt surfaceShortening of radius by 5mm; # ulnar styloid process (60%); widened distal radioulnar jt space by 2mm; subluxation of distal radioulnar jtComplications: malunion, nonunion, instability of DRUJ; damage to ulnar nerve and ant interosseous branch of median nerveMng: ORIF0Reverse Monteggia; # midshaft or distal 1/3 radius with dsilcated distal radioulnar joint; 3x more common than MonteggiaMOI: FOOSHXR: radial styloid should project 8-18mm distal to radioulnar jt; distal radius should articular with at least ? lunate; ulna and radius should be meet to form smooth jt surfaceShortening of radius by 5mm; # ulnar styloid process (60%); widened distal radioulnar jt space by 2mm; subluxation of distal radioulnar jtComplications: malunion, nonunion, instability of DRUJ; damage to ulnar nerve and ant interosseous branch of median nerveMng: ORIFEssex-Lopresti #2336800222250Fractured radial head and dislocation of distal radioulnar jtFractured radial head and dislocation of distal radioulnar jt Hume #3365500149225Fractured olecranon with radial head dislocated anteriorlyFractured olecranon with radial head dislocated anteriorlyColles #1765300109220Transverse # distal radius 4cm prox to wrist, with dorsal + radial angulation and displacement; possible prox displacement and dorsal comminution; assoc ulnar styloid # in 60% (always give it a pull if this is present as suggests serious disruption of inf radio-ulnar joint); may be intra-articular extensionGive it a pull if: >10deg dorsal angulation; >5deg radial angulation; 2-5mm radial shortening; intra-articular step >2mm traction, extension, 10deg flexion, full ulnar deviation POP 5-6/52Transverse # distal radius 4cm prox to wrist, with dorsal + radial angulation and displacement; possible prox displacement and dorsal comminution; assoc ulnar styloid # in 60% (always give it a pull if this is present as suggests serious disruption of inf radio-ulnar joint); may be intra-articular extensionGive it a pull if: >10deg dorsal angulation; >5deg radial angulation; 2-5mm radial shortening; intra-articular step >2mm traction, extension, 10deg flexion, full ulnar deviation POP 5-6/52OT if: >20deg dorsal angulation; >5mm radial shortening; >1cm displacement; >50% dorsal comminution; palmar metaphseal comminution; intra-articular disruption; assoc ulna/carpal #; severe OP; assoc NVI or tendon inj; shearing #; open; impaired contralateral wrist; splitting of radial fragment; failed conservative trtComplications: shoulder + wrist stiffness (30%); median nerve compression (5-10%; palmar paraesthesia; if still present after pull, OT); malunion (5%); delayed union (1-2%); nonunion (0.2%); complex regional pain syndrome (1-4%); EPL rupture (3%; due interrupted vascular supply; occurs 4-8/52 later); compartment syndrome (0.25%; usually anterior); triangular fibrocartilage complex inj; radioulnar and radiocarpal instability; arthritisTorus #130810071120Buckle # distal radius, undisplaced; mechanically stable; POP 2-4/52Buckle # distal radius, undisplaced; mechanically stable; POP 2-4/52Smith’s #2222500107950# distal radius 1-2.5cm prox to wrist with volar displacement and angulation (Reverse Colle’s); garden spade deformityMOI: fall on back of handMng: traction in supination and wrist extension; above elbow POP 6/52; may need ORIF esp if adult# distal radius 1-2.5cm prox to wrist with volar displacement and angulation (Reverse Colle’s); garden spade deformityMOI: fall on back of handMng: traction in supination and wrist extension; above elbow POP 6/52; may need ORIF esp if adultBarton’s #2222500107315Dorsal / volar rim # of distal radius extending intraarticularily; dorsal rim more common; carpals usually subluxed or dislocated with fragment in same direction; unstable as ligamentous inj assoc; ORIF needed; can do closed reduction if <50% jt surface involved and no carpal subluxation0Dorsal / volar rim # of distal radius extending intraarticularily; dorsal rim more common; carpals usually subluxed or dislocated with fragment in same direction; unstable as ligamentous inj assoc; ORIF needed; can do closed reduction if <50% jt surface involved and no carpal subluxationHenderson (Chauffeur’s) #222250078105Radial styloid # from kickback; POP; most ligaments attach onto radial styloid so can be carpal instability; ORIF if displaced / POP fails; may be assoc with lunate dislocation, scapholunate dissociation, trans-styloid perilunar dislocation, dorsal Barton’s #Radial styloid # from kickback; POP; most ligaments attach onto radial styloid so can be carpal instability; ORIF if displaced / POP fails; may be assoc with lunate dislocation, scapholunate dissociation, trans-styloid perilunar dislocation, dorsal Barton’s #Ulnar styloid #Rarely significant; usually assoc with Colle’sNotes from: ................
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